BIOLOGY 
LIBRARY 


LECTURES  ON 

MILITARY  SANITATION 


AND  MANAGEMENT 
OF  THE 


SANITARY  SERVICE 


ARMY  SERVICE  SCHOOLS 


FIELD  SERVICE  AND  CORRESPONDENCE  SCHOOL 
FOR  MEDICAL  OFFICERS 


Fort  Leaven  worth: 
ARMY  SERVICE  SCHOOLS  PRESS 


1917 


Lecture 


MILITARY  HYGIENE 

HYGIENE  is  the  science  which  deals  with  the 
preservation  of  the  health.  Its  existence  de- 
pends on  past  scientific  discoveries.  Sanitation  is 
the  method  which  is  adopted  to  carry  out  the  prin- 
ciples of  hygiene.  Sanitary  methods  may  differ,  but 
yet  be  effective,  in  the  same  way  that  many  prob- 
lems in  geometry  may  be  solved  by  different  meth- 
ods. Sanitation,  therefore,  is  the  application  of 
scientific  discoveries  to  prevent  disease.  "Military 
sanitation"  should  be  used  instead  of  the  words  "mi- 
litary hygiene"  as  hygiene  covers  all  principles  to 
insure  health  and  application  of  these  principles  in 
the  military  service  is  the  method  of  dealing  with 
men  living  under  conditions  somewhat  foreign  to 
those  that  civilziation  has  caused  to  exist. 

A  medical  officer  has  many  duties  to  perform. 
There  is  hardly  anything  pertaining  to  a  soldier  that 
he  is  not  in  some  way  required  to  make  recommenda- 
tions or  act  on  his  own  initiative,  but  his  principal 
duty  in  time  of  war  is  to  initiate  the  proper  sanitary 
measures,  and  without  your  intelligent  help  as  offi- 
cers he  will  not  be  entirely  successful.  The  greatest 
achievements  towards  military  efficiency  in  our  ar- 
my, so  far,  have  been  accomplished  by  the  medical 
corps  by  scientific  discoveries  and  their  application, 
and  the  officer  who  is  now  in  command  of  men,  and 
who  does  not  give  this  subject  the  proper  attention 
must  necessarily  be  a  failure. 

In  all  the  wars  that  history  records  (possibly 
with  the  exceptions  of  the  Russo-Japanese  war,  and 
3 


) .«    -  .      -4-,— 

the  present  disturbance  abroad)  much  more  disa- 
bility and  many  more  deaths  have  resulted  from 
disease  than  from  wounds.  The  failures  of  armies 
on  account  of  preventable  diseases  are  not  few. 
Arnold  in  1775  was  unsuccessful  because  small-pox 
and  dysentery  incapacitated  the  command.  "  In  1802, 
15,000  of  Napoleon's  army  perished  in  Santo  Do- 
mingo of  yellow  fever  and  other  preventable  tropical 
diseases.  The  British  in  the  Crimea  lost  twenty- 
five  times  more  men  from  disease  than  from  wounds. 
In  the  Spanish- American  war  there  were  seven  times 
more  deaths  from  sickness  than  was  caused  by  the 
enemy.  During  the  Balkan  wars  cholera  in  the  Bul- 
garian army,  and  typhus  fever  in  Servia  during  the 
present  war  greatly  influenced  the  results  of  the 
attack  in  the  former,  and  the  defense  of  the  latter. 

The  Selection  of  Recruits 

It  is  quite  evident  to  you,  as  common  sense 
teaches,  that  it  is  desirable  to  have  men  accepted  in 
the  Army  who  are  the  best  physical  specimens,  and 
also  men  somewhat  intelligent  and  mentally  alert. 
In  a  small  army  when  men  desire  to  enlist  in  great 
numbers  this  selection  can  be  made ;  but  there  are  so 
many  men  who  have  slight  imperfections  that  this 
degree  of  perfection  will  never  be  reached  when  a 
great  number  of  men  are  called  out  for  active  ser- 
vice. 

At  the  present  time  War  Department  Orders 
prescribe  certain  requirements  regarding  height, 
weight,  chest  measurements,  age,  hearing  and  vision 
for  recruits,  and  no  departure  can  be  made  from 
these  requirments  without  special  authority  from 
The  Adjutant  General  of  the  Army.  Past  experi- 
ence has  shown  that  it  is  not  desirable  to  accept  men 
who  are  outside  of  the  limits  set  forth  in  the  rules 


for  the  examination  of  recruits.  Besides  good  phy- 
sique, the  soldier  should  be  of  good  character  and 
habits,  mentally  alert,  with  fair  education  and  of 
normal  temperament. 

In  time  of  peace,  heretofore,  the  number  of  men 
rejected  for  enlistment  were  three  or  four  to  one 
accepted. 

During  the  recent  mustering  into  the  United 
States  service  of  the  National  Guard  (militia)  great 
pressure  was  brought  to  bear  on  the  War  Depart- 
ment to  accept  officers,  especially,  who  had  been  re- 
jected physically.  An  attempt  was  made  to  main- 
tain the  standard  of  the  regular  army  in  regard  to 
the  National  Guard,  but  it  was  found  to  be  impos- 
sible, yet  most  of  the  physically  unfit  were  elim- 
inated. During  war,  and  the  longer  that  war  contin- 
ues, the  physical  standard  must  necessarily  be  low- 
ered, in  order  to  obtain  men. 

System  of  Examination. — Up  to  1907  the  phy- 
sical examinations  were  made  largely  by  civilian 
physicians,  employed  under  contract,  at  recruiting 
station  in  cities.  Under  this  system  great  losses  of 
men  occurred  as  a  result  of  disabilities  discovered 
after  the  recruit  had  been  sworn  in.  At  the  same 
time  the  government  spent  much  money  for  the 
transportation  and'  clothing  of  these  defectives, 
while  company  commanders  became  dissatisfied  on 
account  of  the  poor  quality  of  the  material  sent  them. 
As  a  result  of  these  undesirable  features  a  system 
has  been  developed  whereby  line  officers  make  a 
careful  preliminary  examination  at  their  recruiting 
stations,  and  forward  likely  candidates  to  depots. 
At  the  latter  points  army  medical  efficers  examine 
these  candidates,  weed  out  the  defective  ones,  and 
enlist  those  qualified.  The  Surgeon  General  reports 
that  "the  present  recruiting  system  operates  in  a 


highly  satisfactory  manner  and  furnishes  to  the 
army  recruits  of  far  better  quality  than  when  they 
were  examined  under  the  former  system/' 

Principal  Defects. — The  physical  deficiencies 
which  cause  the  greatest  number  of  rejections  for 
our  army  are:  venereal  diseases,  heart  abnormali- 
ties, defective  vision  or  hearing,  foot  deformities, 
and  poor  physique.  While  it  is  not  to  be  expected 
that  line  officers  on  recruiting  duty  shall  be  able  to 
detect  obscure  affections  of  the  internal  organs, 
there  are  many  grosser  defects  which  are  readily 
apparent  to  them.  Such  are:  deformities,  skin 
eruptions,  pallor,  emaciation,  inebriety,  venereal  dis- 
ease, defective  development  of  parts,  lice,  dirty  per- 
son, rupture,  piles,  stiff  joints,  varicose  veins,  flat 
feet,  indecent  tattooing,  etc.  Furthermore,  internal 
disease  may  be  suspected  from  shortness  of  breath, 
a  thumping  heart,  dimness  of  vision,  or  irregular 
pulse  following  moderate  exertion. 

Character. — The  character  of  the  applicant 
should  be  determined  as  accurately  as  possible.  He 
may  satisfy  all  the  physical  requirements,  but  when 
the  recruiting  officer  asks  himself  the  question: 
"Would  I  be  willing  to  have  this  man  in  my  com- 
pany?" there  is  often  a  decided  negative.  And 
this  test  is  a  useful  one  to  apply  with  respect  to  the 
intelligence  of  the  applicant,  his  knowledge  of  Eng- 
lish, and  his  general  appearance.  The  moral  qual- 
ifications may  be  guessed  from  his  features  and  s*aze 
(open,  frank  or  averted),  his  manner  (direct  or  fur- 
tive and  hang-dog),  his  person  and  clothing  (clean 
or  dirty).  He  may  present  the  well-known  appear- 
ance of  a  drunkard  or  tramp.  Drug  habits  may  be 
indicated  by  numerous  marks  of  the  hypodermic 
needle  or  very  contracted  pupils.  A  marked  dis- 
proportion of  features  or  limbs  may  be  indications 


of  degeneracy,  or  his  body  may  be  much  tatooed, 
some  of  the  subjects  being  of  an  obscene  or  other- 
wise offensive  nature. 

Mental  and  Nervous  Condition. — The  men- 
tal and  nervous  condition  is  important.  A  nervous 
shifty,  or  excitable  manner ;  wandering  attention ; 
defective  memory;  inability  to  give  prompt  or  di- 
rect replies  to  questions;  sudden,  jerky  movements, 
will  frequently  indicate  an  unstable  nervous  sys- 
tem or  defective  mentality. 

Age. — Youth  is  a  serious  physical  defect.  We 
sometimes  read  the  erroneous  statement  that  the 
Civil  War  was  fought  by  boys,  but  in  that  war, 
as  in  all  those  of  history,  undeveloped,  immature 
youths  succumbed  to  the  fatigues  and  privations  of 
campaign  in  vastly  greater  proportion  than  grown 
men.  Prior  to  the  age  of  twenty-one  the  bones  are 
not  fully  formed,  the  muscles  lack  endurance,  and 
the  heart  is  unduly  susceptible  to  overstrain.  On 
the  other  hand,  men  over  thirty,  unless  they  have 
led  an  active,  alert  life,  are  apt  to  be  muscle-bound 
and  mentally  slow.  The  limits  of  age  for  our  service 
are,  in  time  of  peace,  eighteen  to  thirty-five.  It  is 
therefore,  to  be  seen  that  minors  may  be  legally  ac- 
ceted  in  spite  of  the  knowledge  that  great  com- 
manders have,  for  centuries  past,  protested  against 
the  recruitment  of  boys  for  their  armies.  From  a 
physiologic  standpoint  the  truly  desirable  minimum 
is  not  less  than  twenty  years. 

Height,  Weight,  Chest. — In  the  absence  of  ac- 
tual diseased  conditions,  the  physical  attributes 
which  chiefly  determine  the  acceptance  or  rejection 
of  an  applicant  for  enlistment  are  the  height,  the 
weight,  and  the  chest  measurements.  In  normal  in- 
dividuals these  bear  a  fairly  definite  relation  to  each 
other,  which  relation  is  set  down  in  official  tables. 


—8— 

Men  whose  chest  circumference,  at  rest,  is  below  32 
inches,  should  not  be  accepted,  for  such  a  chest  has 
not  sufficient  air  capacity.  The  present  minimum 
of  height  is  5  feet  1  inch.  The  question  of  height 
is  not  quite  so  important  now  as  in  the  days  of 
shock  action.  Other  things  being  relatively  equal, 
the  smaller  man  is  generally  quicker  in  his  move- 
ments and  has  more  endurance.  In  these  days  of 
specialism  we  might  well  accept  vigorous  men  who 
are  a  little  shorter  that  the  present  requirement  for 
special  service,  thus  releasing  others  of  standard 
height  for  the  fighting  line.  With  respect  to  weight, 
men  of  the  "wiry"  type  may  be  accepted  when  they 
are  but  a  few  pounds  under  the  standard,  but  the 
mistake  must  not  be  made  of  confusing  these  with 
cases  of  defective  or  arrested  development.  In 
these  latter,  deficiency  in  weight,  pallor,  flabby  mus- 
cles, a  flat  chest,  sloping  shoulders,  and  generally 
poor  physique  denote  a  feeble  constitution. 

Records. — It  is  essential,  for  the  protection  of 
the  government,  that  careful  records  be  made:  (a) 
of  all  departures  from  the  normal,  including  minor 
ones  which  are  not  considered  disqualifying,  and  (b) 
of  means  of  identification.  The  first  is  needed  as  a 
defense  against  unjust  claims  for  pension.  The  sec- 
ond leads  to  the  detection  of  criminals,  deserters, 
bounty  jumpers,  and  dishonorably  discharged  men 
who  enlist  fraudulently. 

Depots. — Owing  to  the  widespread  derivation 
of  recruits,  depots  for  their  collection  and  training 
are  frequently  afflicted  with  one  or  more  kinds  of 
contagious  diseases,  brought  by  some  who  have  con- 
tracted them  elsewhere.  It  has  sometimes  happened 
that  measles,  mumps,  or  some  other  communicable 
disease  has  developed  in  parties  of  men  sent  from 
depots,  during  the  trip  or  shortly  after  arrival  at 


— 9— 

their  destination.  Army  posts  have  thus  been  fre- 
quently infected,  while  the  health  of  the  traveling 
public  has  been  endangered.  If,  therefore,  such  a 
disease  exists  at  depots,  the  men  who  have  been  ex- 
posed to  contagion  should  be  isolated,  in  separate 
squads,  until  the  period  of  incubation  of  that  par- 
ticular disease  is  past.  If  a  case  develops  in  any 
one  squad,  none  but  members  of  that  squad  have 
been  exposed  to  it  and  the  others  may  safely  be  for- 
warded. A  similar  procedure  is  advisable  in  carnps. 
Vaccination. — One  of  the  first  requirements 
after  the  enlistment  of  a  man  is  to  have  him  vac- 
cinated against  smallpox  and  typhoid  fever.  This 
is  a  very  important  procedure,  looking  to  his  future 
health  and  that  of  the  army. 

Personal  Hygiene 

Nature  and  Importance. — Personal  hygiene 
means  preservation  of  health  by  attention  to  the  care 
of  the  body.  It  is  obvious  that  such  care  is  essen- 
tial to  keep  the  physical  character  of  the  soldier  up 
to  the  proper  standard.  Napoleon  is  reported  to 
have  said:  "The  most  important  quality  of  the 
soldier  is  his  ability  to  support  fatigue  and  privation ; 
physical  courage  is  only  second."  Whether  or  not 
this  be  true,  it  must  be  apparent  to  any  thinking 
individual  that  personal  merits,  including  courage, 
are  of  little  avail  to  the  military  man  if  he  has  not 
bodily  vigor. 

Formation  of  Correct  Habits. — Military  ef- 
ficiency in  an  individual,  then,  rests  upon  certain  con- 
siderations, chief  among  which  are  health,  strength, 
and  activity.  To  secure  and  keep  these  qualities  it 
is  essential  for  every  man  to  form  such  habits  as  ex- 
perience has  shown  to  benecessary.  These  habits 
are:  personal  cleanliness;  regulation  of  diet;  avoid- 


—10— 

ance  of  execesses  (particularly  in  eating,  drinking, 
and  sexual  matters)  ;  wearing  suitable  clothing; 
keeping  the  bodily  processes  at  work  (kidneys,  bow- 
els, skin)  ;  taking  sufficient  exercise,  preferably  in 
the  open  air ;  devoting  a  proper  part  of  each  day  to 
rest  of  the  body  and  mind,  with  recreation  for  the 
latter ;  maintaining  the  surroundings  in  which  one 
lives,  in  a  cleanly  state. 

Personal  Cleanliness. — The  maintenance  of  per- 
sonal cleanliness  is  even  more  necessary  in  the 
military  service  than  in  civil  life.  This  is  due  in 
part  to  the  violent  exercises  required  of  the  soldier, 
with  the  resultant  dirt  and  sweat,  but  especially  be- 
cause so  many  live  together  within  a  small  space. 

Baths  and  Bathing. — The  most  important  re- 
quirement to  insure  cleanliness  is  bathing.  Baths 
are  necessary  partly  to  rid  the  skin  of  external  im- 
purities, but  chiefly  to  keep  open  the  pores,  which 
are  the  mouths  of  the  sweat-glands,  whose  product 
carries  away  large  amounts  of  waste  and  poisonous 
matters  from  the  blood.  Each  man  has  a  prefer- 
ence for  a  certain  temperature  of  the  water  in  which 
he  takes  his  bath ;  this  varies  from  freezing  to  hot. 
A  cold  bath  is  stimulating  and  is  to  be  preferred  for 
a  vigorous  man,  provided  he  "reacts"  well  and  feels  a 
glow  on  emerging  from  the  bath  and  rubbing  down. 
The  cold  bath  is  not  suited  to  elderly  men  nor  to 
those  whose  circulation  is  poor.  The  proper  time 
for  cold  bathing  is  on  arising  in  the  morning,  not  at 
bedtime,  as  sometimes  indulged  in. 

It  is  worthy  of  mention  that  the  practice  of  cold 
bathing  often  breaks  up  the  habit  of  "taking  cold," 
to  which  certain  people  are  liable. 

Hot  and  warm  baths  are  soothing  and  best  re- 
move surface  dirt;  they  are  grateful  means  of  re- 


—11— 

ducing  muscular  soreness  after  exertion,  and  will 
often  induce  sleep  in  a  restless,  wakeful  person. 

The  most  desirable  means  of  bathing  is  perhaps 
in  a  tub  in  which  the  whole  body  may  be  immersed ; 
in  default  of  this  and  particularly  in  barracks,  the 
shower-bath  is  very  satisfactory.  If  means  for  com- 
plete bathing  are  not  available,  careful  attention 
should,  in  any  event,  be  given  to  the  daily  cleansing 
of  the  armpits,  crotch  and  feet,  as  well  as  the  hands 
and  face.  The  hands  should  be  washed  after  defeca- 
tion and  urination,  lest  they  convey  disease  germs. 
The  nails  must  be  well  kept  and  clean.  On  the 
march,  if  no  water  is  available,  a  vigorous  "dry  rub" 
with  a  coarse  towel  will  be  found  refreshing  as  well 
as  cleansing.  The  scalp  should  be  washed  at  least 
once  or  twice  a  month  and  should  be  stimulated 
daily  by  brisk  rubbing  with  a  brush  or  the  fingers. 

Care  of  the  Teeth. — Every  man  should  own  a 
good  tooth  brush  and  use  it  with  a  tooth  powder  or 
mild  antiseptic  (listerine  for  instance)  at  least  twice 
a  day.  If  no  tooth  powder  is  available,  wood  ashes 
or  wood  charcoal  make  efficient  substitutes. 

Clothing. — Since  clothing  (especially  the  un- 
derwear) when  soiled  writh  sweat  and  dust  is  irrita- 
ting to  the  skin  and  gives  off  disagreeable  odors,  it 
is  necessary  to  keep  this  as  clean  as  the  body.  The 
soldier  cannot  keep  his  person  clean  if  his  garments 
are  filthy.  Therefore,  whenever  possible,  the  soiled 
clothing  should  be  washed  (and  with  soap  if  it  can 
be  had).  If  the  articles  are  of  wool,  they  should  be 
washed  in  tepid  water  and  dried  without  wringing. 
On  the  march  a  man  should  have  two  suits  of  under- 
clothes to  wear  on  alternate  days,  thus  ensuring 
cleanliness  if  the  garments  are  regularly  washed.  If, 

at  the  end  of  the  day's  march,  water  is  not  available 

i 


—12— 

for  this  purpose,  the  garments  should  be  dried,  then 
beaten  or  well  rubbed,  and  hung  up  in  the  air. 

Skin  Diseases. — In  campaign,  skin  diseases  due 
to  animal  parasites  especially  lice  and  the  itch  mite 
usually  make  their  appearance  and  cause  much  dis- 
gust and  discomfort.  They  must  be  watched  for 
and  report  of  their  presence  promptly  made  to  the 
medical  officer. 

Diet. — In  the  soldier's  life  the  diet  is,  of  course, 
regulated  as  far  as  possible  by  the  authorities,  who 
design  and  issue  the  ration  and  train  the  cooks  by 
whom  the  articles  composing  it  are  prepared.  In 
campaign,  military  considerations  may  necessitate 
cutting  away  from  the  base  of  supply,  so  that  sol- 
diers are  obliged  to  live  on  the  resources  of  the  coun- 
try in  which  they  are  operating  or  even  to  subsist 
for  a  few  days  upon  the  emergency  ration.  Every 
soldier  should  be  required  to  learn  how  to  prepare 
his  individual  field  ration,  since  the  necessity  for  this 
frequently  occurs  in  field  service. 

The  character  of  the  food  taken  should  vary  in 
accordance  with  the  coonditions  of  bodily  vigor,  oc- 
cupation, climate,  and  food  values.  A  vigorous  man, 
doing  heavy  work,  requires  more  nourishment  than 
one  of  delicate  physique  following  a  sedentary  pur- 
suit. Climate  is  an  important  factor.  Men  serving 
in  Alaska  need  a  large  amount  of  fats  to  serve  as 
fuel  in  maintenance  of  the  temperature  balance. 
Those  on  duty  in  the  Philippines  require  a  largo 
proportion  of  sugars  and  starches. 

Dietary  Don'ts. — A  few  general  dietary  prin- 
ciples follow,  which  may  perhaps  best  be  expressed 
in  the  form  of  prohibitions : 

Don't  eat  hurriedly. 

Don't  swallow  a  morsel  till  it  is  thoroughly 
broken  up  and  mixed  with  the  saliva  by  chewing. 


—13— 

Don't  overload  your  stomach,  but  get  up  from 
the  table  feeling  that  you  could  eat  a  little  more 
with  .relish. 

Don't  eat  unripe  or  overripe  fruit. 

Don't  eat  anything,  while  away  from  camp  or 
barracks,  whose  materials  or  mode  of  preparation 
may  seem  questionable. 

Don't  bring  worry  or  a  "grouch"  to  the  table 
with  you. 

Excess  in  Eating. — Overeating  gives  rise  to 
biliousness  and  other  forms  of  dyspepsia  and  over- 
loads the  body  tissues  with  waste  matters.  These 
wastes  are  irritant  substances  and  are  just  as  likely 
as  alcohol  to  cause  kidney  disease,  gout,  obesity,  and 
hardening  of  the  arteries.  Beefy,  overfed  men  are 
especially  liable  to  apoplexy. 

Excess  in  drinking  means,  to  us  all,  overuse  of 
drinks  containing  alcohol  in  some  form.  You  will 
learn  that  the  great  majority  of  violations  of  dis- 
cipline, trials  by  courts-martial,  and  subsequent 
punishment  in  our  army  result  from  this  particular 
excess.  Habitual  indulgence  in  alcohol  brings,  as 
certain  rewards,  a  host  of  physical  and  mental  ail- 
ments. Besides  weakening  men  physically,  alcohol 
tampers  with  their  will  power  and  makes  them  less 
trustworthy  even  when  sober. 

Sexual  Indulgence. — It  is  the  popular  idea  that 
a  young  man  must  exercise  the  sexual  function 
to  some  extent  in  order  that  he  may  retain  his  vigor. 
This  belief  is  not  founded  on  fact,  for  the  sexual  act 
is  not  necessary  to  preserve  the  health  or  powers  of 
a  man.  Not  only  is  this  true,  but  it  is  equally  true 
that  sexual  indulgence  by  young  unmarried  men  is 
responsible  for  an  immense  amount  of  disease  and 
suffering.  This  disease  and  suffering  is  borne  not 
only  by  the  men  themselves,  but,  in  a  large  propor- 


—14— 

tiori  of  cases,  by  the  innocent  women  whom  they 
afterward  marry  and  by  their  children.  The  wives 
may  be,  and  often  are,  infected  years  after  an  ap- 
parent cure  has  resulted  and  the  children  are*  born 
diseased. 

Clothing. — The  prime  purpose  for  which  cloth- 
ing is  worn  (other  than  that  of  decency)  is  to 
afford  protection  to  the  body  against  extremes  of 
cold  and  heat.  The  materials  used  should,  therefore, 
be  such  as  to  conserve  the  natural  warmth  of  the 
body  or  to  allow  it  to  escape  freely,  in  accordance 
with  weather  conditions.  Clothing  should  not  be 
permitted  to  interfere  with  the  circulation  of  the 
blood,  nor  with  the  normal  movements  of  the  body. 

Excretory  Function. — Our  bodies,  in  the  work 
their  various  parts  must  perform,  manufacture  cer- 
tain waste  products  which  we  call  excretions.  Now 
it  is  evident  that  if  we  do  not  get  rid  of  these  sub- 
stances, they  will  clog  up  the  body  or  even  act  as 
poisons.  Nature  has,  therefore,  designed  certain 
avenues  of  escape  for  these  excretions,  and  the  chief 
of  these  are  the  skin,  the  kidneys,  the  bowels,  and 
the  lungs.  The  importance  of  the  skin  has  already 
been  dwelt  upon.  The  kidneys  can  best  be  kept  in 
good  condition  by  drinking  plenty  of  water  (at  least 
6  or  8  glasses  a  day),  which  flushes  these  organs 
and  dilutes  the  solid  impurities  of  the  urine.  Con- 
stipation induces  a  variety  of  uncomfortable  con- 
ditions, among  which  piles,  headache,  the  state  often 
called  "biliousness,"  and  mental  depression  are  fre- 
quent. Therefore,  remember  to  keep  your  bowels 
open. 

Lungs. — The  lungs  are  an  important  avenue  of 
escape  for  certain  waste  products,  chief  of  which  is 
carbon  dioxide.  The  ventilation  of  living  rooms 
thus  becomes  desirable  to  dilute  or  cary  off  these 


—15— 

wastes,  to  renew  that  most  vital  element,  oxygen, 
and  to  prevent  overheating,  and  undue  moisture  of 
the  atmosphere,  which  latter  are  important  factors 
tending  to  the  diminution  of  vitality.  The  germs  of 
diseases  which  affect  the  respiratory  tract  are 
throwrn  off  into  the  air  and  are  likely  to  be  breathed 
by  healthy  individuals,  who  are  thus  in  turn  infected. 
"Colds"  result  more  often  from  overheated,  poorly 
ventilated  rooms  than  as  the  result  of  drafts  and 
chilling.  Such  colds  are  often  contagious.  The 
transmission  of  tuberculosis  and  such  acute  infec- 
tious diseases  as  measles,  scarlet  fever,  influenza, 
and  whooping  cough  is  favored  by  poor  ventilation. 

Exercise. — A  sufficient  amount  of  exercise  to 
maintain  health  is  ordinarily  provided  by  military 
drills  and  other  dfities  requiring  active  movement. 
Nevertheless,  the  physical  condition  is  further  im- 
proved, muscular  size  and  strength  greatly  increased, 
and  the  mental  outlook  rendered  more  cheerful  by 
athletic  exercises,  whether  in  the  open  air  or  the 
gymnasium.  A  proper  appreciation  of  the  benefits  of 
physical  exercise  may  be  gained  by  a  mental  com- 
parison between  the  rugged  condition  of  a  man  who 
exercises  regularly,  and  the  poorly  developed  mus- 
cles and  sallow  skin  of  another  who  has  some  oc- 
cupation which  keeps  him  indoors  at  work  of  a  light 
sort.  The  improvement  is  brought  about  by  the 
increased  activity  not  merely  of  the  muscles,  but  of 
every  part  of  the  body,  including  the  heart,  lungs, 
skin,  digestive  apparatus,  etc.  Like  all  good  things, 
however,  exercise  may  be  overdone;  excessive  ra- 
pidity or  irregularity  of  the  heart's  action  and 
labored  breathing  are  warnings  to  stop  and  rest. 
Soldiers  in  campaign  especially  immature  boys  who 
are  somtimes  enlisted  are  very  liable  to  heart  strain 
and  an  "irritable"  condition  of  that  organ. 


-16- 

Arteries. — "A  man  is  as  old  as  his  arteries," 
and  some  men  grow  old  in  this  respect  much  sooner 
than  the  average,  so  care  must  be  taken  to  suit  the 
exercise  to  their  condition. 

The  amount  and  kind  of  exercise  best  suited  to 
each  must  be  determined,  as  these  vary  widely  in 
different  individuals.  There  are  men  who  require 
the  equivalent  of  a  brisk  15  mile  daily  walk  to  keep 
in  a  satisfactory  physical  state,  while  the  ordinary 
occupation  of  others  suffices  to  maintain  them  in 
excellent  health. 

Rest. — For  the  repair  of  damaged  tissues  and 
the  relief  of  fatigue,  a  certain  amount  of  rest  for 
both  mind  and  body  is  necessary.  Different  people 
vary  considerably  in  their  requirements,  but  it  may 
be  set  down  as  a  fair  average  that  eight  hours  of 
sleep  in  each  twenty-four  hours  are  needed  to  keep 
the  faculties  at  their  best.  In  addition,  work  of  any 
sort,  physical  or  mental,  must  be  intermitted  by 
brief  period  of  relaxation.  Mental  overwork  is  very 
common  in  these  days  of  complex  civilization,  and 
exhaustion  of  the  nervous  system  (neurasthenia) 
takes  a  long  time  for  its  recovery. 

Recreation. — The  risk  of  overtaxing  the  mind 
is  greatly  lessened  by  measures  of  recreation,  which 
may  take  any  proper  form  most  agreeable  to  the  in- 
dividual. The  cultivation  of  a  fad  is  of  especial 
value.  The  habit  of  worry,  of  "crossing  bridges 
before  one  comes  to  them,"  must  be  avoided.  Fits 
of  "the  blues,"  if  yielded  to,  tend  to  increase  in  num- 
ber and  length  and  finally  to  unfit  one  for  work. 
In  garrison,  on  transports,  and  particularly  in  winter 
camps  during  war  time,  we  must  make  provision  for 
measures  of  recreation.  These  are  essential  to  pro- 
mote cheerfulness  and  contentment,  and  to  lessen  the 
tendency  to  abuse  of  alcohol  and  tobacco,  gambling, 


—17— 

and  perversion  of  the  generative  function.  Enter- 
tainments of  all  sorts,  but  more  particularly  those 
participated  in  by  the  men  themselves,  competitions 
and  contests,  reading  rooms,  and  opportunities  for 
following  and  learning  mechanical  trades  must  be 
provided. 

Cleanliness  of  Surroundings. — It  is  not  suffi- 
cient merely  to  keep  our  bodies  in  a  state  of  cleanli- 
ness by  the  measures  previously  outlined.  We  must 
also  keep  our  surroundings — the  house  and  grounds 
in  which  we  live — well  "policed,"  as  the  expression 
goes  in  our  military  service.  It  is  self-evident  that 
where  people  live — especially  where  many  people 
are  congregated  in  a  small  space — there  much  dirt 
will  collect.  This  refers  not  so  much  to  earthly 
particles  as  to  the  so-called  organic  materials  which 
are  derived  from  animal  and  vegetable  sources. 
Under  this  head  fall  the  body  discharges,  refuse 
from  the  kitchen,  decaying  flowers  and  weeds,  cigar 
stubs,  floor  and  stable  sweepings,  and  the  like. 
These  must  be  received  in  vessels  specially  kept  for 
them  and  frequently  removed,  or  they  give  off  foul 
odors,  pollute  the  ground,  attract  hosts  of  flies,  and 
act  as  breeding  places  for  the  germs  of  disease. 

Preventable  Diseases 

In  the  first  place,  the  fact  must  be  recognized 
that  there  are  no  diseases  peculiar  to  soldiers.  There 
is  not,  by  reason  of  their  occupation  or  mode  of  life, 
any  abnormal  physical  condition  engendered  which 
has  not  its  counterpart  among  civilians.  On  the 
other  hand,  there  are  certain  departures  from  a 
state  of  health  to  which  soldiers  are  especially  liable 
because  of  their  work  and  environment.  Newly 
raised  troops  and  recruits  generally  have  the  highest 


—18— 

disease  rates.    Old  soldiers  are  inured  to  service  and 
have  learned  how  to  care  for  themselves. 

Dependency  of  Soldiers. — "The  men  who  corn-- 
pose an  army  are  drawn  from  civil  life,  in  which  each 
individual  has,  to  a  greater  or  less  extent,  independ- 
ent control  of  his  time,  choice  of  occupation,  selec- 
tion of  food  and  dwelling  place,  and  general  sanitary 
care.  -After  enlistment,  soldiers  lose  most  of  this 
independence ;  they  are  housed,  clothed,  fed,  and  ex- 
ercised under  regulations  which  it  is  beyond  their 
power  to  amend ;  they  are  moved  from  one  point  to 
another,  differing  perhaps  very  widely  in  climatic 
and  other  conditions,  under  orders  which  they  may 
not  presume  to  question ;  their  hours  for  sleep,  meals, 
work,  and  recreation  are  fixed  for  them  without  con- 
sultation with  them  or  without  regard  to  individual 
or  communal  preference/'*  (Harrington.) 

Inexperienced  Soldiers. — In  our  military  sys- 
tem the  absolute  dependence  on  the  will  or  neglect  of 
a  superior  is  especially  prone  to  result  in  disease 
conditions,  because  of  the  ignorance  and  inexperience 
of  militia  and  volunteers  suddenly  called  into  active 
service.  The  officers  have  little  or  no  knowledge  of 
the  care  of  troops,  while  the  men  exhibit  a  reckless- 
ness and  disregard  for  the  laws  of  health  perculiarly 
national.  The  American  volunteer,  unless  firmly 
commanded,  displays  the  utmost  indifference  to  the 
ordinary  rules  of  decency.  He  deposits  his  excre- 
ment where  he  happens  to  be ;  he  drinks  of  any  liquid 
he  encounters  which  may  be  dignified  by  the  name  of 
water;  he  throws  his  wastes  indiscriminately  upon 
the  camp  ground,  heedless  of  the  fact  that  putre- 
factive changes  will  shortly  make  them  offensive; 
he  gleefully  seeks  opportunities  for  alcoholic  and 
sexual  excesses ;  and,  in  defense  of  his  heaven-born 
liberties,  he  often  declines  to  mend  his  ways  because 


—19— 

he  enlisted  to  fight  and  not  to  perform  menial  occu- 
pations. The  necessity  on  the  part  of  line  officers 
for  familiarity  with  the  preventable  diseases  to 
which  the  soldier  is  liable  and  with  the  fundamental 
sanitary  principles  necessary  for  their  prevention 
thus  becomes  apparent. 

Venereal  Disease. — Of  all  the  ills  from  which 
the  soldier  suffers,  those  consequent  upon  venery 
affect  his  effciency  to  the  greatest  extent.  Our  ar- 
my is  made  up  mainly  of  young,  unmarried  men, 
freed  from  the  moral  restraints  of  home,  often  with- 
out opportunity  for  association  with  decent  women 
and  susceptible,  to  the  suggestion  of  the  vicious. 
There  must  be  some  outlet  for  their  surplus  energies. 
They  visit  places  of  amusement,  many  of  which  are 
maintained  with  the  sole  object  of  pandering  to  vice, 
where  strong  liquor  and  the  advances  of  lewd  wonjen 
combine  to  break  down  such  moral  defenses  as  they 
may  possess.  Unless  prevented  by  legal  enactment 
the  lowest  kinds  of  "dives"  cluster  round  the  en- 
trances to  army  posts.  The  soldier  has  a  right  to 
his  amusements  and  we  must  strive  to  furnish  such 
as  will  attract  him  more  than  evil  resorts ;  to  secure 
the  passage  of  laws  preventing  the  establishment  of 
low  brothels  at  our  gates ;  and  to  build  up  the  moral 
stamina  of  our  men  by  education. 

Statistics  show  that  at  least  a  third  of  all  women 
who  give  their  bodies  for  immoral  purposes  are  suf- 
fering from  some  form  of  veneral  disease.  This  in- 
cludes not  merely  the  professional  prostitute,  but 
the  chorus  girl,  "saleslady,"  or  mill  hand,  who,  to 
satisfy  her  love  for  finery  or  for  other  reasons,  may 
eke  out  a  scanty  income  by  occasional  lapses  from 
virtue.  It  is  a  medical  axiom  that  every  prostitute 
becomes  infected  with  syphilis  inside  of  two  or  three 


—20— 

years.    It  is,  therefore,  easy  to  see  that  the  risks  of 
contagion  are  very  great. 

The  American  people  have,  until  recently,  shun- 
ned public  discussion  of  venereal  matters  through 
what  may  now  seem  to  have  been  mistaken  pru- 
dery. A  great  movement  has  lately  been  instituted, 
through  the  American  Association  for  Sex  Hygiene 
and  allied  societies,  looking  to  the  awakening  of  the 
public  conscience  and  the  moral  education  of  the 
youth  of  the  land. 

Prevalence  in  the  Army. — Venereal  infec- 
tions are  responsible  for  an  enonjious  amount  of 
sickness  in  the  army — vastly  more  than  any  other 
cause — and  constitute  the  most  important  health 
problem  with  which  we  have  to  deal.  There  are 
constantly  on  the  sick  report  from  this  cause  a  num- 
ber of  men  which  more  than  equals  the  strength  of 
a  regiment  of  infantry.  Our  army  has  the  unenvia- 
ble distinction  of  having  a  much  greater  amount  of 
sickness  of  this  nature  than  any  foreign  army. 
Moreover,  since  the  Spanish- American  War  the  ratio 
of  such  cases  has  rapidly  increased,  until  it  is  now 
twice  as  much  as  in  1898.  The  situation  must, 
therefore,  be  fairly  faced  and  every  effort  put  forth 
to  determine  the  causes  for  the  prevalence  of  ven- 
ereal diseases  and  to  devise  measures  for  their  pre- 
vention. 

That  the  army  has  a  greater  percentage  of  such 
disease  than  has  an  equal  number  of  vigorous  young 
unmarried  men  drawn  from  like  source  in  civil  life 
is  not  believed.  Such  infections  cause  the  largest 
proportion  of  rejections  of  applicants  for  enlistment. 
They  honeycomb  our  social  structure.  In  point  of 
prevalence  they  vastly  outnumber  all  other  infectious 
diseases,  both  acute  and  chronic,  combined. 


—21— 

Causes. — These  are  not  far  to  seek.  In  the  first 
place,  sexual  desire  is  implanted  in  man  as  a  compel- 
ling factor  for  the  perpetuation  of  the  race.  This 
desire  is  strong,  especially  when,  by  previous  exer- 
cise of  the  function,  the  habit  has  been  formed. 
Next,  the  demand  for  partners  in  the  sexual  rela- 
tion has  always  created  a  supply,  and  prostitution  is 
as  ancient  as  history.  Of  late  this  supply  has  been 
elevated  to  the  dignity  (?)  of  a  business,  and  a 
hideous  traffic,  with  an  intricate  system  for  procur- 
ing young  girls  and  suborning  those  who  legally 
should  prevent  such  traffic,  is  now  strongly  en- 
trenched. 

Preventive  Measures. — How,  then,  shall  we 
set  about  to  minimize,  as  far  as  possible,  the  inci- 
dence and  effects  of  these  loathsome  diseases,  largely 
dependent,  as  they  are,  upon  causes  inherent  in  the 
nature  of  mankind?  From  a  sanitary  standpoint 
is  is  plain  that  we  must  apply  the  ordinary  prin- 
ciples of  sanitation.  That  is,  we  must  recognize 
their  contagious  character  and  apply  such  preven- 
tive measures  as  are  effective  in  other  transmissible 
diseases.  The  most  important  measure  of  this  char- 
acter is  the  isolation  of  infected  individuals  until  the 
danger  of  transmission  is  past.  In  the  army  we  can 
and  do  control  our  infected  soldiers,  but  the  women 
from  whom  their  disabilities  were  derived,  as  well 
as  infected  male  civilians,  are  still  at  large  to  spread 
the  contagion  further.  It  is  obvious,  therefore, 
that,  if  we  hope  for  success,  sentimentalism  and  pru- 
dery must  give  way,  and  that  diseased  public  women 
must  be  admitted  to  hospitals  or  otherwise  placed 
under  restraint  till  the  infectious  stage  of  the  disease 
is  over.  For  the  diseased  male,  it  should  be  made 
a  crime  knowingly  to  spread  a  venereal  disease. 


22 

Education. — The  measures  above  outlined  do 
not  conform  with  the  yet  uneducated  public  feeling 
that  it  is  immoral  openly  to  recognize  diseases  of 
this  class  and  their  chief  transmitter,  the  prosti- 
tute. On  the  other  hand,  the  measures  themselves 
are  certainly  not  immoral,  while  they  are  practical. 
On  the  moral  side,  the  campaign  of  education  already 
begun  should  be  extended  and  a  flood  of  light  poured 
upon  the  subject,  that  all  may  clearly  understand 
sex  matters,  the  dangers  as  well  as  the  immorality 
of  illicit  intercourse  and  the  methods  of  spread  of 
diseases  transmitted  thereby.  With  such  education, 
the  veil  of  ignorance,  misinformation,  and  prudery 
will  be  lifted  and  the  tendency  to  secret  vices  among 
children  will  be  lessened.  Havard  says  truly.  "It 
is  in  the  conscience  of  the  young  man  that  prophy- 
laxis should  begin/'  The  knowledge  of  sexual  mat- 
ters acquired  by  a  child  is  from  bad  sources  and  of  a 
perverted  kind.  Such  knowledge,  secretly  acquired 
and  brooded  over  in  secret,  hastens  the  awakening  of 
sexual  feeling  and  leads  to  vice. 

Action  by  the  War  Department. — Our  War 
Department  has  acted  with  courage  and  vigor  in 
attacking  this  problem.  Orders  were  issued  in  1912 
directing  procedures  as  follows: 

I.  That   physical   inspections   of   enlisted   men 
should  be  made  twice  each  month  for  the  detection  of 
venereal  disease. 

II.  That  any  soldier  who  exposes  himself  to  in- 
fection shall  report  for  cleansing  and  preventive 
treatment  immediately  upon  return  to  camp  or  garri- 
son. 

III.  That  any  soldier  who  fails  to  so  report,  if 
found  to  be  suffering  from  a  venereal  infection,  shall 
be  brought  to  trial  by  court  martial  for  neglect  of 
duty. 


—23— 

IV.  That   men   so   diseased   shall   be   confined 
strictly  to  the  limits  of  the  post  during  the  infectious 
stages  of  the  disease. 

V.  That  all  officers  serving  with  troops  shall  do 
their  utmost  to  encourage  healthful  exercises  and 
physical  recreation  and  to  supply  opportunities  for 
cleanly  social  and  interesting  mental  occupations  for 
the  men  under  their  command. 

VI.  That   company  and  medical   officers    shall 
take  advantage  of  favorable  opportunities  to  point 
out  the  misery  and  disaster  which  follow  upon  moral 
uncleanliness  and  the  fact  that  venereal  disease  is 
never  a  trivial  affair. 

Action  by  Congress. — Congress,  too,  has  taken 
a  decided  stand,  by  an  enactment  providing  that  no 
officer  or  enlisted  man  who  shall  be  absent  from 
duty  on  account  of  disease  resulting  from  his  own 
intemperate  use  of  drugs,  or  alcoholic  liquors,  or 
other  misconduct,  shall  receive  pay  for  the  period  of 
such  absence. 

It  will  be  seen  from  the  foregoing  that  the  army 
now  has  an  excellent  plan  for  the  discouragement  of 
vice  and  the  control  of  disease  resulting  therefrom. 
It  is,  however,  in  the  highest  degree  desirable  to  keep 
the  men  away  from  more  evil  influences,  and  it  is 
notorious  that  the  saloon,  prostitution,  and  profes- 
sional gambling  go  hand  in  hand.  The  close  rela- 
tion between  alcoholic  excess  and  sexual  indulgence 
is  an  interesting  fact.  A  man's  passions  are  in- 
flamed by  liquor,  his  will  power  and  his  judgment  are 
alike  weakened,  and  he  yields  to  conditions  which 
in  his  sober  moments  might  be  positively  offensive 
to  him. 

Syphilis. — There  are  three  kinds  of  venereal 
disease.  The  most  serious  to  man  is,  perhaps, 
syphilis  (sometimes  called  the  "pox,"  and  referred 


—24— 

to  in  the  newspaper  advertisements  of  charlatans 
as  "blood  disease")-  This  is  due  to  a  very  active, 
corkscrew-shaped  protozoal  germ.  Its  first  appar- 
ent result  is  an  open  sore  at  the  point  of  infection. 
This  sore,  known  as  a  hard  chancre,  does  not  appear 
for  several  weeks  after  exposure,  but  is  then  very 
resistant  to  treatment  and  remains  for  a  month  or 
more.  The  body  is  soon  infected  throughout,  and 
symptoms  of  this  condition  appear  most  often  in 
the  form  of  skin  eruptions  and  glandular  swellings. 

Syphilis  is  an  infection  of  the  entire  system  and 
its  manifestations  are  practically  innumerable.  We 
may  expect  it  to  appear  in  any  conceivable  form,  and 
where  a  chronic  case  of  disease  is  obscure,  tests 
often  reveal  its  presence.  Certain  of  these  mani- 
festations may  (and  do)  appear  many  years  after 
the  disease  was  contracted.  Among  these  are  pare- 
sis (softening  of  the  brain)  and  locomotor  ataxia. 

Syphilis  is  extremely  difficult  to  cure,  and,  in  a 
certain  proportion  of  cases,  never  is  cured.  The  new 
remedy — "606"  or  salvarsan — is  still  in  the  experi- 
mental stage,  but  it  is  at  least  certain  that  its  use 
is  not  followed  by  permanent  recovery,  and  that  the 
older  and  more  prolonged  forms  of  treatment  must 
still  be  employed.  Syphilis  is  the  disease  which  is 
so  often  transmitted  to  the  children — "even  unto  the 
third  and  fourth  generation,"  as  the  Good  Book  in- 
forms us — as  well  as  to  the  wife.  It  may  be  trans- 
mitted to  others  not  only  by  sexual  contact,  but  also 
by  means  of  articles  (such  as  towels,  eating  and 
drinking  utensils,  a  comrade's  pipe)  used  in  common. 
Cases  also  are  frequently  met  which  have  been  inno- 
cently acquired  through  kissing,  surgical  or  dental 
operations,  the  ministrations  of  a  nurse,  and  numer- 
ous other  blameless  ways. 


—25— 

The  danger  of  transmission  of  the  disease  from 
father  to  child  (hereditary  syphilis)  is  very  con- 
siderable. Many  children  are  born  dead ;  others  die 
soon  after  birth ;  still  others  (who,  though  diseased, 
may  survive)  show  characteristic  deformities  or 
unmistakable  syphilitic  lesions. 

Marriage. — "Marriage  of  a  syphilitic  is  per- 
missible only  after  five  years,  during  the  last  two 
of  which  he  has  been  without  symptoms  and  without 
treatment"  (Keyes). 

Gonorrhea,  or  "clap,"  is  the  result  of  infection 
with  the  bacterial  germ  known  as  the  gonococcus, 
and  is  characterized  by  a  profuse  purulent  discharge 
from  the  affected  part.  This  is  usually  the  canal  of 
the  penis  (the  urethra)  in  the  male,  although  any 
mucous  or  serous  membrane  may  be  involved.  Thus 
if,  by  carelessness  or  misfortune,  a  little  of  the  pus 
is  transferred  to  the  eye,  a  most  violent  inflammation 
ensues  and  the  sight  is  in  grave  danger  of  destruc- 
tion. Gonorrheal  rheumatism  is  a  common  and  in- 
tractable affection.  Heart  disease  is  an  occasional 
sequel. 

Gonorrhea  is  even  more  frequently  conveyed  to 
the  wife  than  syphilis,  and  with  most  serious  results, 
as  thousands  of  deaths  and  tens  of  thousands  of 
chronic  invalids  attest;  60  to  80  per  cent,  of  pelvic 
suppurations  in  women  are  due  to  this  affection. 
The  eyes  of  babies  become  infected  during  birth. 
It  is  estimated  that  25  per  cent,  of  blind  people  owe 
their  infirmity  to  this  cause. 

Gonorrhea  is  popularly  regarded  as  something 
of  a  joke,  an  affection  but  little  more  harmful  than 
a  cold  in  the  head ;  but  many  surgeons  look  upon  it 
as  more  serious  than  syphilis  in  its  results,  for  the 
infection  has  a  way  of  traveling  along  the  various 
routes  to  the  bladder,  kidneys,  and  testicles,  leaving 


—26— 

a  man  permanently  injured  and  often  greatly  short- 
ening his  life.  Gonorrhea  is  transmitted  to  inno- 
cent people — wife,  child,  comrade — with  extreme 
ease,  so,  if  thus  affected,  one  cannot  be  too  careful 
to  make  sure  that  none  of  the  discharge  is  brought 
in  contact  with  a  healthy  individual.  Cotton  or 
other  material  soiled  with  the  discharge  should  be 
burned  or  otherwise  safely  disposed  of. 

Chancroid.  —  The  third  venereal  disease  — 
chancroid  or  soft  chancre — is  a  contagious  ulcer.  It 
is  always  local,  never  constitutional,  and  has  no  re- 
lation to  syphilis  (although  it  is  frequently  necessary 
to  wait  for  weeks  before  one  can  be  sure  it  is  not 
the  latter).  Its  cause  is  a  special  bacillus.  While 
it  may  occur  elsewhere,  it  is  practically  always  found 
about  the  genitals.  Though  less  serious  than  the 
other  diseases  of  this  class,  it  is  a  painful  and  repul- 
sive affection.  In  about  one-third  of  the  cases  it  is 
accompanied  by  an  abcess  in  the  groin  known  as  a 
bubo. 

Personal  Prophylaxis.  —  Reference  has  been 
made  ealier  in  this  lecture  to  the  War  Department 
requirement  that  enlisted  men  who  have  exposed 
themselves  venereal  infection  shall  report  at  hqs- 
pital  or  dispensary  for  cleansing  and  preventive 
treatment,  but  it  may  be  said  that  the  procedures 
used  are  very  successful  in  the  prevention  of  infec- 
tion. Objection  has  been  made  that  such  prevention, 
by  making  licentiousness  safe,  encourages  the  latter. 
As  already  shown,  our  problem  is  to  keep  our  soldiers 
physically  fit,  and  purely  sentimental  considerations 
are  of  secondary  importance.  Moreover,  our  navy 
has  given  the  system  a  fair  trial,  and  finds  an  actual 
diminution  in  percentage  of  exposures  as  the  result 
of  the  campaign  of  education. 


—27— 

In  the  absence  of  legitimate  intercourse  (that  is, 
married  life)  nature  will  relieve  the  situation  by 
an  occasional  nocturnal  emission,  which  is  in  no 
sense  harmful.  The  cultivation  of  pure  thought, 
the  avoidance  of  temptation,  cold  baths,  simple,  non- 
stimulating  diet,  vigorous  physical  exercise,  and  al- 
coholic abstinence  will  prove  efficacious  in  overcom- 
ing desire. 


Lecture     II 


MILITARY  HYGIENE 

Water,  Food,  Fly,  and  Carrier-Borne  Diseases 
Typhoid  Fever 

TYPHOID  fever  (or  enteric,  as  the  English  call  it) 
has  for  many  years  been  known  as  "the  scourge 
of  armies."  In  our  Civil  War  the  Union  Army  had 
over  80,000  cases  recognized  as  such,  and  there  were 
probably  as  many  more  which,  because  of  imperfect 
means  of  diagnosis,  were  thought  to  be  malaria  and 
other  infections. 

War  of  1870. — The  Germans,  in  the  war  with 
France  in  1870,  had  over  73,000  cases  and  nearly 
7,000  deaths,  although  active  hostilities  lasted  but 
six  months. 

Boer  War. — The  British  Army  in  South  Africa, 
while  fighting  with  the  Boers,  had  57,000  cases  and 
8,000  deaths. 

War  of  1898. — In  our  war  with  Spain  we  had 
20,738  cases,  with  1,580  deaths,  among  108,000  men, 
all  occurring  within  three  and  a  half  months ;  1  man 
in  every  6  had  the  disease,  while  this  proportion  was 
increased  to  1  in  5  among  those  regiments  which 
never  left  the  United  States.  Typhoid  fever  caused 
nine-tenths  of  all  deaths  occurring  among  troops 
encamped  in  the  United  States  in  1898. 

Such  instances  might  be  multiplied  indefinitely, 
but  enough  has  been  said  to  show  what  an  immense 
amount  of  sickness  and  military  inefficiency — to  say 
nothing  of  the  suffering  and  death  of  individuals, 
with  economic  loss — this  dreaded  disease  causes. 

29 


—30— 

How  Spread. — Typhoid  bacilli  find  the  most 
favorable  soil  for  growth  and  increase  in  the  bowels 
of  human  beings ;  they  are  usually  found  also  in  the 
urine  of  infected  individuals.  The  disease  is  spread, 
therefore,  by  the  discharges  of  such  individuals  gain- 
ing access  to  the  intestinal  canals  of  others  through 
swallowing  substances  contaminated  with  the  germ. 
This  may  happen  directly  by  contact  with  a  diseased 
person  or  indirectly  through  infected  water,  milk, 
uncooked  fruit  and  vegetables,  dust,  flies,  soiled 
hands,  garments,  bedding,  or  tentage. 

If  we  had  a  perfect  method  of  disposal  of  these 
waste  products  of  the  body,  it  would  not  be  long 
before  typhoid  fever  would  cease  to  appear  in  epi- 
demic form,  and  only  an  occasional  case  would  be 
encountered  as  the  result  of  direct  contact  with  an 
infected  individual.  But,  under  the  imperfect  sani- 
tary conditions  of  modern  existence,  it  will  be  a  long 
time  before  this  is  realized,  and  in  the  meanwhile 
we  must  employ  such  measures  as  will  reduce  to  a 
minimum  the  risks  of  contact  with  infectious  ma- 
terial. 

Army  Epidemics. — Typhoid  fever  is  more  likely 
to  become  epidemic  in  military  than  in  civil  life 
because  of  the  greater  difficulty  in  disposing  of 
wastes,  and  the  close  crowding  and  intimate  contact 
of  young  men  under  the  conditions  of  camp  and 
barrack  life.  A  man  affected  with  typhoid  may 
scatter  the  germs  of  the  disease  widely  before  its 
existence  is  recognized  in  himself,  since  it  frequently 
happens  that  mild  cases  are  not  detected  for  a  week 
or  two  from  their  onset.  Moreover,  3  to  4  persons 
in  every  100  who  have  recovered  from  attacks  con- 
tinue to  breed  the  germs  in  their  bodies  and  to  dis- 
charge them  with  their  excretions.  We  call  such 
chronically  infected  individuals  "carriers."  Such  a 


—31— 

man,  by  defecating  in  the  nearest  brush,  stepping 
just  outside  his  tent  at  night  to  urinate,  or  failing 
to  cover  his  discharges  in  the  sink  (whereby  flies 
may  have  access  to  them,  to  convey  the  filth  to  food 
in  nearby  kitchens  a  little  later)  may  be  sowing  the 
seeds  of  the  scourge  broadcast.  Each  man  who  thus 
offends  seems  to  think  he  is  the  only  one  who  does 
such  a  trick  and  so  it  won't  do  any  harm.  Unfor- 
tunately, many  of  his  comrades  are  looking  at  the 
matter  from  the  same  point  of  view.  And  flies  are 
not  necessarily  the  agents  in  this  matter.  Let  us 
again  assume  one  infected  individual  in  camp.  His 
habits  as  to  cleanliness  may  be  bad  or  his  opportuni- 
ties therefor  poor.  At  any  rate,  his  hands  are  sure 
to  be  soiled  with  infectious  material,  which  he  trans- 
fers to  everything  he  touches — clothing,  bedding, 
towel,  the  cigars  or  matches  he  proffers  to  a  comrade, 
and  even  the  food  of  others  which  he  handles — for  he 
may  be  company  cook  or  cook's  police.  His  saliva 
is  infectious  and  he  fouls  the  common  drinking  cup 
or  a  pipe  which  another  may  use.  Or,  again,  a 
soldier's  shoes  may  be  soiled  with  the  filth  deposited 
upon  the  ground  by  a  careless  comrade.  This  ma- 
terial is  carried  about  the  camp  and  into  the  tents, 
and,  since  the  typhoid  bacillus  may  live  for  a  time 
in  the  earth,  a  puff  of  wind  of  a  friendly  scuffle 
whirls  the  infected  dust  in  the  air,  whence  it  is 
likely  to  be  blown  upon  food  and  thus  swallowed. 
By  such  means  not  one  but  dozens  of  men  are  in- 
fected, and  with  each  new  case  the  risks  grow  in 
geometric  progression.  In  the  multitude  of  cases 
during  the  Spanish-American  War,  impure  water 
played  little  or  no  part.  The  three  factors  almost 
wholly  responsible  for  these  cases  were  uncovered  ex- 
creta, flies  attracted  thereby,  and  personal  contact 
with  infected  individuals. 


—32— 

Prevention. — Now,  what  is  the  "ounce  of  pre- 
vention" in  this  case  ?  It  consists,  first,  in  the  pre- 
liminary anti-typhoid  vaccination  of  men  believed 
to  be  susceptible ;  second,  in  a  campaign  of  education 
(which  must  be  shared  by  line  and  medical  officers 
alike)  in  the  facts  just  related;  third,  in  the  protec- 
tion of  the  water-supply;  fourth,  in  the  systematic 
and  thorough  disposal  of  excreta  and  organic  wastes 
generally ;  and  fifth,  in  sharp  punishment  for  viola- 
tions of  sanitary  regulations. 

Anti-typhoid  Vaccination. — In  anti-typhoid  in- 
jections we  now  have  a  method  of  protection  against 
this  disease  which  is  quite  as  efficacious  as  is  vac- 
cination against  small-pox.  It  is  well  known  that 
an  attack  of  typhoid  usually  protects  a  man  against 
a  subsequent  attack.  Only  1  case  in  143  has  typhoid 
a  second  time,  and  the  method  of  protection  referred 
to  is  found  to  confer  immunity  in  a  similar  way  and, 
it  is  thought,  to  an  equal  degree 

It  is  in  our  own  service  that  the  procedure  has 
been  most  thoroughly  tested  and  its  value  definitely 
proved.  Vaccinations  of  officers  and  men  who  volun- 
teered for  the  purpose  were  commenced  in  1909. 
The  results  were  so  good  that  in  1911  the  procedure 
was  made  compulsory  for  all  under  forty-five  years 
of  age  who  had  never  had  the  disease.  The  navy 
followed  suit,  and  immunization  of  both  services  is 
now  practically  complete.  A  single  instance  of  the 
value  of  the  prophylactic  measure  to  our  service 
will  suffice.  This  takes  the  form  of  a  comparison 
between  an  army  division  in  Florida  during  the 
Spanish  War  in  1898  and  a  division  in  Texas  during 
the  border  troubles  in  1911.  Conditions  as  to 
strength  of  command,  climate,  season,  purity  of 
water-supply,  and  duration  of  camp  were  approxi- 
mately equal.  The  disposal  of  wastes  was  much 


—33— 

superior  in  the  latter  camp,  but  the  complete  im- 
munization of  the  Texas  command  by  means  of  the 
anti-typhoid  prophylactic  constituted  the  conspicu- 
ous difference : 

Mean  Cases  of  typhoid       Deaths  from 

Year  strength        (certain    and    probable)      typhoid 

1898—                            - 10,759  2,693  248 

1911 12,801  2  0 

Dysentery 

Dysentery  remains  the  most  serious  of  the 
diseases  to  which  our  people  in  the  Philippines  are 
liable.  Broadly  speaking,  dysentery  is  any  inflam- 
matory disease  of  the  bowels  in  which  blood  and 
mucus  appear  in  the  stools.  Based  upon  their  cau- 
sative factors  there  are  two  types,  the  one  due  to 
animal  (protozoal),  the  other  to  vegetable  (bacter- 
ial) parasites. 

Amebic  Type. — The  principal  form  of  dysentery 
under  the  first  head  is  caused  by  an  ameba,  a  minute 
animal  consisting  of  a  single  cell.  This  is  the  type 
which  causes  most  trouble  in  the  Philippine  Islands ; 
it  is  also  met  with  in  our  Southern  States.  The 
amebae  enter  the  body  with  food  or  water  and  pro- 
duce inflammations  and  ulcerations  of  the  large  intes- 
tine, which  are  sometimes  complicated  by  abscesses 
of  the  liver.  Their  natural  home  appears  to  be  the 
human  intestine,  and  from  this  source  they  con- 
taminate foods  (especially  fruits  and  green  vegeta- 
bles) and  drinking  water. 

BacillSry  Type. — The  bacterial  type  of  dysen- 
tery is  caused  by  the  bacillus  dysenteriae.  Bacillary 
dysentery  can  only  be  told  from  the  amebic  form  by 
an  expert,  but  for  our  purposes  this  fact  is  unimport- 
ant, since  our  preventive  measures  are  the  same 
for  both.  This  type  is  very  widely  distributed  over 
temperate  as  well  as  hot  climates,  and  is  the  one 


—34— 

which  is  responsible  whenever  epidemic  outbreaks 
occur  in  an  army.  The  bacilli  are  conveyed  from 
fecal  matter  to  the  mouth  by  contaminated  food  or 
drink.  Flies  are  comman  agents  of  transference  and 
personal  contact  plays  as  large  a  part  as  in  typhoid. 
As  a  result  of  their  presence  in  the  bowel  and  the 
development  of  poisons  (toxins)  resulting  from  their 
activities,  ulcerations  of  the  large  intestine,  hemor- 
rhages therefrom,  and  great  prostration  result.  This 
form  is  usually  more  active  and  dangerous  than 
the  amebic,  being  sometimes  almost  as  rapidly  fatal 
as  cholera. 

Camp  Diarrheas. — Diarrheas  are  very  common 
in  field  service  and  may  result  from  a  variety  of 
causes,  such  as  bad  food,  certain  kinds  of  water,  poor 
cooking,  or  abdominal  chilling.  There  is  also  an 
epidemic  form  (heretofore  referred  to  as  camp  diar- 
rhea) which  attacks  large  numbers  of  men  at  one 
time  and  is  severe  in  character.  One  cause  of  epi- 
demic diarrhea  is  the  dysentery  bacillus,  which 
occasionally  manifests  its  activities  thus,  but  any 
form  of  diarrhea  is  bad,  since  it  not  only  rapidly 
weakens  a  man,  but,  by  irritating  the  intestines,  it 
increases  the  liability  to  attack  by  the  more  serious 
affections,  typhoid  fever  and  dysentery.  Under  con- 
ditions of  active  service  the  importance  of  "carriers" 
of  typhoid,  dysentery,  and  epidemic  diarrheas  is 
greater  than  in  civil  life.  Indeed,  these  probably 
constitute  the  most  important  of  all  factors. 

Prevention. — Preventive  measures  f 6r  all  forms 
of  dysenteries  and  camp  diarrheas  are  identical 
with  those  for  typhoid  fever  save  in  the  matter  of 
vaccination,  for  which  we  do  not  as  yet  possess 
an  efficient  agent.  The  water-supply  should  be  care- 
fully protected  from  fouling;  the  feces  of  men  sick 
with  these  diseases  should  be  disinfected  or  other- 


—35— 

wise  safely  disposed  of ;  the  sick  should  be  separated 
from  the  well;  and  all  sources  of  irritation  of  the 
intestinal  tract  should  be  avoided. 

Cholera 

Cholera,  whose  normal  home  is  the  tropics,  is 
by  no  means  confined  to  warm  climates,  but  is  fre- 
quently brought  to  our  own  shores.  Since  we  know 
its  cause  (the  "comma"  bacillus)  and  the  fact  that 
the  measures  for  its  control  are  similar  to  those  for 
typhoid  fever,  we  do  not  fear  that  it  will  affect  a 
lodgment  in  the  United  States.  Cholera  has  given 
us  much  trouble  in  the  Philippines,  but  even  there, 
where  sanitary  measures  are  carried  out  with  greater 
difficulty,  its  invasions  have  been  met  and  checked. 

Flea-Borne  Diseases 
Plague 

Plague,  the  "black  plague"  of  the  Middle  Ages, 
establishes  itself  independently  of  climate  wherever 
it  finds  favorable  conditions.  It  has  been  demon- 
strated that  rats  are  even  more  liable  to  this  disease 
than  man,  and  it  is  well  established  that  infection 
is  usually  incurred  through  the  bite  of  the  rat  flea, 
which  after  the  death  of  its  normal  host,  forsakes 
the  latter  and  attacks  man.  Rats  should,  therefore, 
be  relentlessly  pursued,  their  haunts  made  inacces- 
sible to  them,  and  opportunities  for  obtaining  food 
cut  off.  Cousins  of  the  rat — such  as  the  prairie  dog 
of  our  western  plains  and  the  ground  squirrel  (tar- 
bagan)  of  California  and  Manchuria — are  subject  to 
the  disease  and  may  be  agents  in  its  transmission. 
In  some  epidemics  a  very  deadly  form  ("pneumonic" 
plague)  attacks  the  lungs.  Here  the  germ  is  trans- 
mitted by  breathing  and  the  flea  is  not  a  factor. 


—36— 

Louse-Borne  Diseases 
Typhus  Fever 

Typhus  fever,  the  "febris  bellica"  of  older 
writers,  has  been  the  scouge  of  armies.  During  the 
Crimean  war  it  caused  more  deaths  than  all  other 
diseases  combined.  All  of  you  know  what  havoc  it 
has  played  in  Servia.  The  great  Von  der  Goltz,  of 
whom  you  will  hear  more  about  in  the  near  future, 
recently  died  with  typhus.  As  it  is  quite  prevalent 
in  Mexico  it  is  of  great  importance  for  you  to  know 
that  vermin  transmit  the  disease  from  one  person  to 
another.  The  destruction  of  vermin  will  wipe  out 
an  epidemic. 

Mosquito-Borne  Diseases 
Malaria 

The  malarial  fevers  constitute  an  important 
class  of  diseases.  Other  names  by  which  they  are 
known  are  ague;  chills  and  fever;  remittent  fever; 
intermittent  fever.  The  dreaded  Chagres  Fever  of 
Panama  is  a  form  of  pernicious  malaria.  There  are 
three  types  of  these  fevers,  each  due  to  a  different 
minute  animal  parasite  which  attacks  the  blood  of 
man,  but  it  is  sufficient  for  our  purpose  here  to  know 
that  all  have  a  similar  origin,  namely,  the  bite  of  an 
infected  mosquito.  The  method  of  transmission  was 
discovered  as  recently  as  1898  by  a  British  Army 
surgeon. 

Anopheles  Mosquitoes. — Only  one  variety  of 
mosquito  (the  anopheles)  which,  however,  has  rather 
numerous  species  is  capable  of  transmitting  the 
germs  responsible  for  the  disease.  The  mosquitoes 
may  be  recognized,  in  their  adult  or  even  larval 
forms,  by  peculiarities  in  their  attitudes  when  at 
rest.  The  larvae  (popularly  called  "wigglers")  of 


—37— 

harmless  (culex)  mosquitoes  lie  head  downward  on 
the  water  in  which  they  are  developing,  with  only 
their  breathing  tubes  in  contact  with  the  surface. 
Those  of  the  anopheles  lie  parallel  with  the  water's 
surface  and  just  beneath  it.  Mosquitoes  themselves, 
when  resting,  show  opposite  peculiarities;  that  is, 
the  common  forms  lie  parallel  with  the  surface  to 
which  they  cling,  while  the  anopheles  rest  with  their 
heads  near  the  surface  and  their  bodies  angling 
away  from  it.  Another  point  of  difference  is  that 
the  common  form  is  humpbacked,  while  the  anophe- 
les is  nearly  straight  from  proboscis  to  tail.  It  is 
worthy  of  remark  that  only  females  are  blood- 
suckers and  thus  transmitters  of  malaria.  The  male 
may  readily  be  recognized  by  the  feathery  tuft  on 
his  head. 

Mode  of  Transmission. — The  transference  of 
the  infection  from  one  man  to  another  is  accom- 
plished in  the  following  manner:  A  certain  indi- 
vidual has  malaria,  which  means  that  he  has  in  his 
blood  the  germs  which  cause  the  disease.  An  ano- 
pheles mosquito  bites  him  and  draws  into  her 
stomach,  along  with  the  blood,  a  number  of  these 
germs,  which  undergo  a  peculiar  form  of  develop- 
ment within  her  body.  After  this  development  is 
complete,  this  mosquito  bites  a  healthy  man,  and, 
injecting  a  little  saliva  through  her  hollow  proboscis 
in  order  to  make  the  blood  more  fluid,  she  thus 
presents  this  second  man  with  a  number  of  undesir- 
able guests  in  the  shape  of  malarial  parasites.  These 
promptly  attack  such  of  the  red  corpuscles  of  his 
blood  as  are  most  available,  and  the  cycle  is  complete. 
Thus,  the  conditions  which  must  exist  to  favor  the 
spread  of  malaria  are :  First,  an  infected  human  be- 
ing; second,  anopheles  mosquitoes;  third,  healthy 
man ;  and  fourth,  opportunity  afforded  to  .the  mos- 


—38— 

quitoes.  The  germ  of  the  disease  is  a  microscopic, 
single-celled  animal  (protozoon).  This  germ  was 
discovered  in  1880  by  a  French  Army  surgeon. 

Prevention. — Preventive  measures  are  as  fol- 
lows ;  first,  precaution  against  mosquito  bites  by  the 
use  of  screens  for  doors  and  windows,  bars  for  beds, 
and  head-nets  and  gloves  when  necessary  at  night; 
second,  the  killing  of  mosquitoes  in  houses  by  fumi- 
gation, trapping,  or  other  means ;  third,  the  destruc- 
tion of  their  breeding  places  (i.e.,  collections  of 
standing  water) ,  associated  with  the  cutting  of  high 
grass  and  underbrush  near  human  habitations ;  and 
fourth,  the  routine  administration  (in  malarious 
localities)  of  small  doses  of  quinine  to  officers  and 
men  and  attached  civilians.  When  an  individual  is 
known  to  be  infected,  he  should  be  screened  with 
especial  care  to  prevent  access  of  mosquitoes  to  him. 
General  Gorgas  is  of  the  opinion  that  when  troops 
are  marching  through  a  malarious  country  the  only 
practical  measure  for  their  protection  is  the  adminis- 
tration of  quinine.  The  theory  of  this  procedure  is 
that  when  the  malarial  parasites  are  introduced  into 
the  blood,  they  find  there  a  substance  hostile  to  them. 
He  says  further,  that  such  anopheles  mosquitoes  as 
may  bite  soldiers  in  campaign,  would  not  likely  be 
infected  unless  the  troops  are  quartered  in  or  camped 
near  some  town.  If  the  camp  is  occupied  for  more 
than  a  day  or  two  the  ground  should,  of  course,  be 
cleared  and  accumulations  of  water  drained  away 
or  oiled. 

Dengue 

Dengue,  better  known  as  "breakbone  fever,"  is 
a  disease  which  causes  much  sickness  among  our 
people  in  the  Philippines,  but  which,  fortunately, 
does  not  terminate  fatally.  In  common  with  malaria 


—39— 

and  yellow  fever,  it  is  transmitted  by  the  bite  of  a 
mosquito,  so  measures  directed  against  this  pest 
receive  an  additional  argument. 

Yellow  Fever 

Thanks  to  the  late  and  deeply  lamented  Major 
Walter  Reed,  of  our  Army  Medical  Corps,  who  de- 
mostrated  the  fact  that  yellow  fever  is  transmitted 
by  the  bite  of  a  certain  mosquito  only,  we  have  suc- 
ceeded absolutely  in  eradicating  this  terrible  disease 
from  Cuba  and  Panama,  where  for  centuries  it  had 
been  prevalent.  This  has  been  accomplished  by  anti- 
mosquito  measures  alone.  The  insect  concerned  in 
the  transmission  of  this  disease  is  known  as  the 
stegomyia  calopus  or  "tiger  mosquito,"  the  latter 
name  resulting  from  its  striped  appearance,  by 
which  it  may  be  recognized.  It  is  peculiar  in  the 
fact  that  it  bites  chiefly  in  the  afternoon.  It  is  a 
house  mosquito,  residing  in  or  near  dwellings,  and, 
since  it  finds  favorable  breeding  conditions  in  water- 
tanks  of  ships,  it  is  often  carried  about  the  world  in 
this  way.  Its  larva,  like  that  of  the  culex,  floats 
head  downward  in  the  water. 

GENERAL  DISEASES  CAUSED  BY  INFECTION 

OF  THE  RESPIRATORY  TRACT  OR  UPPER 

DIGESTIVE  TRACT.     INFECTION  BY 

CONTACT  WITH  DISCHARGES 

OF  CARRIERS 

Tuberculosis 

Tuberculosis  is  what  is  commonly  known  as 
"consumption,"  because  of  the  wasting  away  of  the 
body  which  is  an  invariable  accompaniment.  The 
tubercle  bacillus,  which  is  responsible  for  this  dis- 
ease, may  and  does  attack  any  part  of  the  human 


—40— 

body,  but  tuberculosis  of  the  lungs  so  greatly  pre- 
ponderates that  when  we  apply  the  term  the  pul- 
monary variety  is  generally  meant.  Though  this 
affection  may  result  from  food  (especially  milk)  con- 
taining the  tubercle  bacillus,  the  usual  channel  of 
infection  is  by  way  of  the  lungs,  the  germs  being 
carried  in  the  air.  A  soldier  with  the  disease  may, 
before  the  condition  is  suspected,  infect  the  air  of 
his  squad  room  to  such  a  degree  that  all  other  sus- 
ceptible individuals  therein  may  contract  the  disease. 

Coughing  and  Spitting. — The  germs  are 
coughed  up  from  their  seat  in  the  lungs;  the  spit- 
ting habit,  as  we  know,  is  one  deeply  engrafted  upon 
the  American  male ;  the  germs  resist  death  by  drying 
to  a  remarkable  degree.  We  are,  therefore,  likely  to 
have  in  barracks  the  conditions  best  suited  to  the 
spread  of  this  disease,  namely,  a  number  of  sus- 
ceptible individuals  closely  aggregated,  an  infected 
man  who  scatters  his  sputum  carelessly  about,  and 
close  air,  breathed  over  and  over  because  of  the  in- 
adequate ventilation  so  dear  to  the  average  crowd. 

Prevention. — The  information  just  given  read- 
ily suggests  the  means  to  be  employed  to  prevent 
the  spread  of  this  affection,  which  are:  first,  the 
exercise  of  great  care  in  recruiting,  to  exclude  those 
in  the  early  stages  of  the  disease ;  second,  the  early 
recognition  of  such  cases  in  the  military  service, 
with  their  removal  to  a  special  hospital ;  to  this  end, 
noncommissioned  officers  should  be  required  prompt- 
ly to  report  any  man  who  has  a  persistent  cough; 
third,  ample  air  space  per  man  in  barracks ;  fourth, 
adequate  ventilation  must  be  provided  for  and  its 
mechanism  carefully  guarded  to  insure  its  continuous 
operation.  In  this  connection  it  is  well  to  state  that 
in  our  service  the  guard-house  is  the  place  most  com- 
monly infected,  since  it  is  usually  overcrowded  and 


—41— 

the  men  of  most  careless  habits  are  apt  to  be  im- 
mured therein. 

Tonsilitis 

Tonsilitis  and  other  throat  affections  are  very 
common  in  barracks  during  cold  weather  and  fre- 
quently occur  in  company  epidemics.  When  such  is 
the  case,  ventilation  is  at  fault,  and  it  will  usually  be 
found  that  the  men,  for  the  sake  of  warmth,  have 
stopped  up  the  air  inlets.  Such  throat  affections  are 
often  quite  severe  and  prostrating  and  may  even  re- 
semble diptheria  at  first.  They  are  not  usually 
due  to  any  one  specific  germ,  but  rather  to  one  or 
more  varieties  of  ordinarily  harmless  bacteria  re- 
siding in  the  throat,  which  have  taken  on  virulent 
properties  by  reason  of  the  lowered  vitality  of  the 
tissues  due  to  bad  air.  The  sick  should  be  isolated 
promptly  and  the  tendency  on  the  part  of  fresh-air 
cowards  to  plug  up  ventilation  shafts  in  cold  weather 
must  be  appreciated  and  combated. 

Influenza 

Influenza,  commonly  known  as  "the  grip," 
occurs  in  epidemic  waves  which  affect  the  civilian 
population  equally  with  the  military,  but  as  this  is 
clearly  infectious,  being  due  to  a  well-known  bacillus, 
and  is  transmitted  chiefly  if  not  wholly  by  contact 
with  the  sick,  such  contact  should  be  avoided  as  far 
as  possible.  The  influenzal  bacillus  prefers  to  attack 
the  respiratory  system,  but  may  affect  the  digestive 
tract  or  the  membranes  surrounding  the  brain  and 
spinal  cord  as  pneumonia,  meningitis,  and  ear  sup- 
purations are  not  unusual.  Marked  depression  of 
spirits  is  a  frequent  accompaniment.  Many  people 
are  cripples  in  health  for  years  after  an  attack. 


—42— 

Colds 

Though  seldom  serious  in  symptoms  or  results, 
common  colds  are  so  frequent  and  temporarily  dis- 
abling that  they  deserve  mention  here.  Many  of 
them  are  undoubtedly  "catching,"  and  persons  suf- 
fering from  them  should  take  pains  to  avoid  close 
contact  with  others.  A  large  percentage  of  cases  is 
due  to  overcrowding  and  faulty  ventilation  in  bar- 
racks. Other  causes  are  wet  feet  and  chilling  fol- 
lowing overheating  of  the  body's  surface. 

Measles 

We  are  apt  to  underrate  the  importance  of  this 
highly  contagious  disease,  which,  in  time  of  war, 
when  new  levies  of  troops  are  brought  together,  be- 
comes a  really  serious  condition.  City-bred  recruits 
have  usually  had  an  attack  in  childhood,  but  those 
from  country  districts  very  likely  have  not  encoun- 
tered the  infection.  The  disease  is  much  more 
severe  in  its  effects  upon  adults  than  upon  children. 
In  the  Union  Army  during  the  Civil  War  there  were 
76,000  cases,  with  more  than  5,000  deaths.  Among 
the  Confederates  whole  brigades  were  temporarily 
disbanded  on  this  account  in  the  early  part  of  the 
war.  No  means  of  prevention  other  than  isolation 
of  the  sick  and  their  attendants  are  at  present 
known.  Measles  is  due  to  a  virus  whose  exact  na- 
ture is  as  yet  unrecognized. 

Mumps 

Mumps  is  also  a  contagious  disease,  and,  like 
measles,  causes  much  disability  among  newly  raised 
troops.  It  is  not  so  serious  in  its  results  as  measles, 
but  is  a  painful  and  disabling  affection,  especially 
when,  as  frequently  happens,  it  attacks  the  testicles. 


—43— 

Its  ordinary  characteristic  is  an  inflammation  of  the 
salivary  glands  located  in  the  neck  near  the  angle 
of  the,  jaw. 

Cerebrospinal  Fever 

Cerebrospinal  fever  (meningitis)  occurs  with 
considerable  frequency  at  recruiting  depots,  on 
transports,  and  in  camps.  Luckily,  though  many  in- 
hale the  micrococcus  which  is  its  cause,  but  few  are 
susceptible  to  the  disease.  Direct  contact  is  respon- 
sible for  the  transference  of  the  infection  and  "car- 
riers" play  a  large  part  in  its  spread.  It  is  a  very 
deadly  disease  unless  antimentingitic  serum  is  used 
promptly.  Early  recognition  of  its  presence  in  the 
command,  rigid  isolation  of  the  sick  and  of  such 
carriers  as  can  be  located,  with  disinfection  of  all 
discharges  from  their  throats  and  noses,  are  the 
essentials  in  its  prevention. 

Scarlatina 

Scarlatina  (scarlet  fever),  though  a  highly  con- 
tagious and  dangerous  disease,  fortunately  attacks 
adults  but  seldom,  so  does  not  need  extended  dis- 
cussion in  this  treatise,  but  a  case  of  sore  throat, 
associated  with  a  brilliant  eruption  on  the  skin, 
should  be  regarded  as  suspicious  of  this  disease  and 
immediately  isolated. 

Diphtheria 

Diphtheria,  another  very  contagious  and  serious 
affection,  is  far  less  feared  since  the  discovery  of 
its  antitoxin.  This  substance  has  great  value  in  the 
prevention  of  the  disease  as  well  as  in  its  cure.  It  is 
given  hypodermically  to  all  persons  exposed  to  the 
infection,  as  well  as  to  the  sick  man. 


—44— 

Small-Pox 

Small-pox,  the  disease  most  dreaded  by  our 
forefathers  because  of  its  repulsiveness,  its  mor- 
tality, and  its  disfiguring  effects,  has  been  robbed  of 
its  terrors  by  the  wonderful  protection  afforded  by 
vaccination,  but  if  the  anti-vaccinationists  had  their 
way  this  loathsome  pest  would  reappear,  deadly  as 
ever,  since  it  is  kept  alive  in  many  communities  by 
those  who  evade  the  means  of  prevention. 

Varioloid  is  simply  a  mild  attack  of  small-pox. 

DISEASES  DUE  TO  EXCESS  OR  DEFICIENCY 
IN  FOOD  PRINCIPLES 

Beriberi 

Beriberi  is  of  interest  and  importance  for  the 
reason  that  it  has  attacked  many  of  our  Filipino 
scouts.  No  perfectly  authenticated  instance  of  its 
occurrence  in  an  American  soldier  is  on  record.  This 
does  not  mean  that  they  are  immune,  but  rather  that 
their  food  contains  the  essential  preventive  sub- 
stances. Rice-eating  peoples  are  most  often  affected, 
and  it  has  been  found  that  some  necessary  food  sub- 
stance resident  in  the  husk  of  the  grain  has  been 
removed  in  the  polishing  process  to  which  the  higher 
grades  of  rice  has  been  subjected.  By  substituting 
an  "undermilled"  rice  for  the  polished  varieties, 
this  disease  has  been  entirely  controlled  among  the 
scouts,  and  its  incidence  much  lessened  among  the 
Filipinos  generally.  This  is  the  latest  instance  of  the 
beneficent  effects,  upon  the  health  of  the  native  popu- 
lations, of  the  occupation  of  tropical  lands  by  the 
American  Army. 


Scurvy 

Seurvy  is  a  disease  resulting  from  scant  or  im- 
proper diet  and  was  formerly  common  among  ar- 
mies and  navies.  It  is  now  but  seldom  encountered, 
although  beleagured  garrisons  (as  the  Russians  in 
Port  Arthur)  and  remote  detachments  (as  in  Alas- 
ka) are  sometimes  affected.  Its  chief  causative  fac- 
tor is  the  absence  from  the  diet  of  organic  acids 
contained  in  fresh  meats  and  vegetables.  Potatoes, 
onions,  tomatoes  (raw  01:  canned),  vinegar,  the 
juices  of  rare  meats,  lemon  and  lime  juice  are  pre- 
ventive and  curative. 

MISCELLANEOUS 
Effects  of  Heat 

The  effects  of  heat  are  frequently  noted  on  the 
march  in  hot  weather.  These  effects  are  of  two 
kinds,  notably  differing  in  symptoms.  In  the  severer 
type  (heatstroke)  the  sick  man  is  unconscious,  his 
face  is  scarlet,  his  pulses  throb  violently,  and  his 
skin  feels  burning  hot.  In  the  other  condition  (  heat 
exhaustion)  the  consciousness  is  retained,  but  the 
man  feels  exhausted,  his  face  is  pale,  his  heart  beats 
feebly,  and  his  skin  is  cold  and  clammy.  Heatstroke 
is  most  apt  to  occur  when  the  aif  is  not  only  very 
warm,  but  is  surcharged  with  moisture  as  well. 
Evaporation  from  the  skin  is  interfered  with,  and 
as  such  evaporation  is  an  important  means  whereby 
excess  heat  is  withdrawn  from  the  body,  the  temp- 
erature may  rise  to  a  dangerous  degree.  These  heat 
effects  can  largely  be  avoided  by  timing  the  march, 
when  possible,  to  take  place  during  the  relatively 
cooler  parts  of  the  day.  The  head  covering  should 
have  a  roomy  air  space  and  the  crown  should  contain 
some  light,  moist  object,  as  a  wet  sponge  or  handker- 


chief  or  green  leaves.  Water  should  be  sparingly 
drunk  on  the  march ;  the  man  who  empties  his  can- 
teen between  halts  is  most  often  the  man  who  is 
overcome  by  heat. 

Skin  Eruptions 

Skin  eruptions  are  very  common  in  campaign, 
for  the  reason  that  men  cannot  or  do  not  keep  their 
persons  and  clothing  in  a  sufficiently  cleanly  state. 
The  affections  which  occur  most  often  are  those  due 
to  the  presence  of  small  animal  parasites.  Of  these, 
lice  are  the  most  objectionable.  The  hirsute  parts  of 
the  head  and  body  should  be  inspected  for  the  eggs 
of  these  insects,  which  are  readily  seen  as  little 
masses  attached  to  the  individual  hairs.  When  in- 
sects or  their  eggs  are  found,  the  man's  undercloth- 
ing should  be  boiled  and  the  affected  parts  of  his 
body  shaved  or  freely  anointed  with  mercurial  oint- 
ment. 

Hookworm  Disease 

Hookworm  disease  has  recently  been  shown  to 
be  of  great  economic  importance  in  Porto  Rico  and 
our  South.  Curiously  enough,  the  animal  source  of 
this  affection,  though  its  home  is  the  human  intes- 
tine, makes  its  way  into  the  body  of  the  person  at- 
tacked through  the  skin  and  not  by  way  of  the 
mouth.  The  eggs  are  passed  out  with  the  feces  and 
the  larvae — which  constitute  the  infective  form — 
hatch  outside  the  body.  The  measures  of  prevention, 
therefore,  consist  of  two  things,  namely,  the  proper 
disposal  of  excreta  and  the  wearing  of  shoes. 


FEET,  CLOTHING  AND  SHOES 
Blistered  Feet 

Large  numbers  of  men  are  incapacitated — par- 
ticularly at  the  onset  of  a  campaign — by  blistered 
feet.  The  two  chief  causes  of  blisters  on  the  feet  of 
the  marching  soldier  are  bad  fitting  shoes  and  un- 
cleanliness.  The  feet  should  be  kept  dry  if  possible ; 
shoes,  when  wet,  wrinkle  and  lose  their  shape.  To 
insure  keeping  the  feet  in  good  condition,  their  daily 
washing,  after  getting  into  camp,  is  absolutely  neces- 
sary. If  sufficient  water  is  not  at  hand,  wipe  the 
feet  carefully — especially  between  the  toes — with  a 
wet  rag. 

Shoes. — The  shoe  is,  at  least  for  the  infantry- 
man, the  most  important  article  of  clothing.  It  is 
only  after  many  years  of  experiment  that  a  rational 
marching  shoe  has  been  developed  for  our  service 
and  the  urgent  necessity  for  exactness  in  the  fitting 
of  each  soldier  with  these  articles  and  for  their  pro- 
per care,  appreciated.  Company  commanders  are 
now  held  responsible  for  undue  injuries  to  the  feet 
of  their  men  from  ill-fitting  footwear.  Each  man 
should  have  at  least  one  pair,  well  broken  in,  for 
marching  use.  Men  should  be  instructed  in  the  care 
of  shoes  and  of  feet,  and  frequent  inspections  of 
both  should  be  made. 

Socks. — An  infantry '  soldier  should  carry  two 
or  three  pairs  of  socks,  which  ought  to  be  soft, 
smooth,  and  undarned.  Those  worn  on  the  day's 
march  should  be  washed  at  the  same  time  as  the 
feet;  clean,  dry  socks  are  then  put  on  and  the  wet 
ones  hung  up  to  dry.  In  this  way  a  clean  pair  may 
always  be  had.  A  woolen  sock  (light  or  heavy)  is 
more  comfortable  when  marching  than  a  cotton  one 
because  it  is  softer  and  more  yielding,  while  it  ab- 


sorbs  the  perspiration  better.  If  perspiration  of  feet 
is  excessive,  a  thin  cotton  sock  under  one  of  light 
wool  does  well. 

Prevention  of  Blisters. — To  prevent  blisters, 
foot  baths  of  strong  brine, or  alum  or  alcohol,  used 
for  a  week  or  more  before  the  march,  are  of  great 
service  in  hardening  the  skin.  Many  experienced 
soldiers  of  our  army  soap  the  feet  before  putting 
on  their  socks.  In  the  German  Army,  socks  (or  rags, 
which  many  wear  for  economy's  sake)  are  soaked 
in  grease.  An  excellent  powder,  made  up  of  starch, 
soapstone,  and  salicylic  acid,  is  supplied  by  our  medi- 
cal department  to  sift  into  the  socks.  These  mea- 
sures are  used  to  diminish  the  friction  of  the  foot 
against  the  sock.  The  French  have  found  that  a 
small  strap  buckled  about  the  instep,  over  the  shoe, 
diminishes  friction  and  lessens  the  tendency  to  the 
formation  of  blisters.  If  such  form  in  spite  of  our 
care,  they  must  be  opened  to  allow  the  serum  to 
escape. 

Treatment. — The  opening  is  made  at  the  lowest 
point  of  the  blister,  with  a  clean  needle,  after  the 
feet  have  been  washed.  The  raised  skin  must  not 
be  disturbed,  but  is  to  be  dressed  with  vaseline  or 
other  ointment  and  protected  from  pressure  by  ad- 
hesive plaster.  Men  afflicted  with  bunions  or  corns 
should  be  required  to  report  promptly  to  the  surgeon 
for  appropriate  treatment. 

Clothing 

Purposes. — Clothing  protects  the  body  against 
the  changing  conditions  of  the  weather,  such  as  cold, 
heat,  wind  and  rain,  shields  in  a  measure  from  blows 
and  bruises,  and  serves  to  adorn  the  person.  The 
materials  used  for  this  purpose  are  derived  from  a 
variety  of  sources,  animal  and  vegetable.  The  chief 


—49— 

substances  taken  from  the  animal  world  are  wool, 
fur,  leather,  and  skin;  from  the  vegetable  kingdom 
we  obtain  cotton,  linen,  and  rubber,  as  well  as  a 
number  of  less  important  materials.  A  good  ma- 
terial for  clothing  purposes  must  meet  the  following 
requirements : 

1.  It  must  afford  proper  protection  against  the 
weather. 

2.  It  must  not  interfere  with  the  natural  func- 
tions of  the  skin. 

3.  It  must  exert  no  irritating  effect  upon  the 
skin. 

The  characteristics  and  merits  of  the  more  im- 
portant substances  will  be  considered  briefly. 

Wool  is  undoubtedly  the  most  valuable  of  these 
substances  used  by  us.  It  has  the  merits  (a)  of 
being  a  poor  heat  conductor,  thus  retarding  escape 
of  warmth  from  the  body  and  preventing  the  thermic 
rays  of  the  sun  from  passing  freely.  Through  its 
heat  conservation  it  is  much  warmer  than  cotton, 
and  when  loosely  woven,  so  that  much  air  is  en- 
tangled in  the  meshes  of  the  fabric,  its  warmth  is 
markedly  increased.  This  property  makes  it  most 
valuable  in  cold  climates,  and  even  in  hot  one  it  is 
not  altogether  undesirable.  The  olive  drab  flannel 
overshirt  has  been  found  to  a  very  valuable  gar- 
ment in  tropical  field  service.  By  day  it  keeps  out 
heat  and  chemical  rays,  and  by  night  it  prevents 
chilling,  (b)  Wool  is  a  great  absorber  of  water,  a 
very  important  quality,  as  evaporation  from  the 
body's  surface  during  free  perspiration  is  checked 
and  the  danger  of  chill  lessened.  Perspiration  passes 
through  linen  and  cotton  freely  and  loss  of  heat  is 
rapid,  (c)  It  does  not  absorb  odors  readily.  A  dis- 
advantage of  wool  is  that  its  fibers  become  smaller 
and  harder  after  washing,  so  that  garments  of  which 


—50— 

it  is  composed  undergo  marked  shrinking  and  stiffen- 
ing. This  tendency  is  minimized  by  washing  as 
follows :  Plunge  garments,  one  at  a  time,  in  warm 
soapsuds  and  use  gentle  friction  to  cleanse  from 
dirt.  Remove  and  rinse  out  all  soap  carefully  with 
cold  water.  Hang  up  to  dry  without  wringing. 
Stretch  into  shape  while  drying  if  a  tendency  to 
shrink  is  observed. 

Cotton  is  next  to  wool  in  value  for  purposes  of 
clothing.  It  has  these  merits:  (a)  Good  wearing 
qualities ;  (b)  cheapness ;  (c)  non-shrinkage  in  wash- 
ing; (d)  coolness.  Its  demerits  are :  (a)  Rapid  heat 
conductivity;  (b)  poor  water  absorption;  (c)  free 
absorption  and  release  of  odors. 

Merino  (a  mixture  of  cotton  and  wool)  is  much 
used  for  underwear. 

Linen  (flax  fiber)  conducts  heat  even  more 
rapidly  than  cotton  and  is  also  a  poor  absorbent  of 
moisture,  besides  being  much  more  expensive  than 
cotton. 

Paper. — It  is  useful  to  know  that  paper  is  of 
value  in  conserving  warmth,  and  the  Japanese  have 
utilized  it  in  military  clothing.  A  paper  vest  affords 
marked  protection  against  cold  winds,  while  a  news- 
paper between  blankets  adds  much  to  comfort  on  a 
cold  night. 

Warmth  and  Coolness. — The  warmth  or  cool- 
ness of  clothing  depends  upon  several  factors :  these 
are  material,  texture,  and  color.  We  have  seen  that, 
according  to  heat  conductivity  the  materials  named, 
in  order  of  warmth,  are  wool,  cotton,  linen.  Con- 
versely, linen  is  coolest.  With  respect  to.  texture, 
the  more  loosely  woven  the  material,  the  warmer  the 
garment.  Thus,  a  cotton  or  linen  loose  mesh  under 
shirt  is  much  superior  to  one  that  is  cloosely  woven. 
The  same  effect  of  warmth  may  be  produced  by  wear- 


—51— 

ing  two  or  more  thin  undergarments,  one  over  the 
other,  the  advantage  resulting  not  so  much  from  the 
increased  thickness  as  from  the  layers  of  warm  air. 
Color  is  of  importance  in  this  connection,  in  accor- 
dance with  its  relative  heat-absorbing  properties. 
Thus,  white  absorbs  least  heat;  black,  the  most. 
Black  clothes  are,  therefore,  wrarmest;  white,  cool- 
est ;  blue  is  next  to  black  for  warmth ;  olive  drab  and 
khaki  are  cooler  than  blue.  Olive  drab,  being  darker, 
is  markedly  warmer  than  khaki. 

Socks  are  furnished  in  cotton  and  in  light  and 
heavy  wool.  Those  of  cotton  are  suitable  for  garri- 
son wear,  but  not  for  marching.  Those  of  light 
wool  (which  are  really  50  per  cent,  cotton)  are  used 
by  the  majority  of  our  men  on  field  service.  The 
heavy  socks,  of  pure  wool,  are  quite  bulky,  but  are 
superior  for  marching  wear,  except  in  the  rare  cases 
in  which  they  cause  skin  irritation.  Wool  absorbs 
perspiration  better,  stretches  better,  and  fits  mere 
uniformly,  so  it  is  less  likley  to  form  creases  and 
produce  blisters,  callouses,  and  corns.  Socks  should 
have  a  seamless  foot,  with  reinforced  toes  and 
heels.  They  should,  fit  well  and  have  no  rough 
thread  ends.  It  is  of  interest  to  note  that  only  two 
armies  other  than  our  own  issue  socks  to  their  ^ol- 
dies. These  are  Great  Britain  and  Japan.  The  great 
military  nations  of  the  European  continent  expect 
their  men  to  provide  themselves  somehow  with  these 
articles,  which  by  us  are  deemed  of  such  importance. 
From  motives  of  economy  many  German  soldiers 
wrap  oil-soaked  cloths  about  their  feet  in  lieu  of 
socks.  A  British  military  sanitarian  (Colonel  Mel- 
ville) estimates  the  life  of  a  sock  to  be  only  60 
to  70  road  miles.  This  is  probably  a  fair  mileage  for 
our  light  wool  sock,  but  it  is  believed  that  the  heavy 
woolen  article  will  do  considerably  better..  Com- 


—52— 

fort  and  cleanliness  as  well  as  regulations  require 
that  socks  shall  be  changed  and  washed  daily  on 
the  march.  It  is  well  to  remember  that  a  piece 
of  soft  cloth  a  foot  square  (wool  or  part  wool) 
will  make  a  better  foot  covering  than  a  worn  out  or 
poorly  darned  sock. 

Shoes. — No  one  article  of  the  soldier's  clothing 
plays  so  large  a  part  in  his  efficiency  as  the  shoe. 
Although  army  commanders  and  sanitarians  of  the 
past  century  have  emphasized  the  importance  of 
good  footwear,  it  is  but  very  recently  that  the  mili- 
tary shoe  has  received  scientific  study.  The  march- 
ing ability  of  armies  is  second  to  no  other  military 
factor,  yet,  while  enormous  percentages  of  troops  in 
campaign  have  been  incapacitated  by  injuries  to  the 
feet  due  to  shoes  badly  made,  shaped  or  fitted,  it  has 
but  lately  been  realized  that  the  conditions  were 
preventable.  A  board  of  officers  convened  for  the 
purpose  by  our  War  Department  has  recently  (1912) 
rendered  its  report  in  the  form  of  a  truly  admirable 
study  of  the  foot  and  the  shoe.  A  number  of  import- 
ant recommendations  are  made  in  this  report,  among 
which  are:  (a)  The  adoption  of  shoes  made  on  a 
rational  last  (one  developed  by  the  board)  ;  (b)  care- 
ful fitting  by  company  officers  personally;  (c)  full 
series  of  sizes  carried  in  stock  at  posts;  (d)  fre- 
quent inspections  of  feet  by  company  and  medical 
officers.  The  War  Department  has  adopted  these 
recommendations  and  has  published  them  in  the 
form  of  an  order,  in  which  occurs  the  following 
sentence:  "Hereafter  an  undue  amount  of  injury 
and  disability  from  shoes  will  be  regarded  as  evi- 
dence of  inefficiency  on  the  part  of  officers  con- 
cerned and  as  cause  for  investigation."  This  places 
the  responsibility  where  it  belongs,  and  officers  will 
do  well  to  study  most  carefully  the  foot  and  its  cover- 


—53— 

ings.  This  may  best  be  done  by  consulting  the 
work  "The  Soldier's  Foot  and  Military  Shoe/'  by 
Major  Munson,  Medical  Corps,  United  States  Army, 
president  of  the  army  shoe  board  above  referred  to. 
Major  Munson  lays  down  the  following  requirements 
for  a  good  military  shoe : 

(a)  It  must  be  of  good  materials  and  well  made. 

(b)  It  must  be  fairly  flexible,  with  pliable  and 
porous  uppers. 

(c)  The  interior  should  be  perfectly  smooth, 
the  heel  broad  and  low,  the  sole  but  moderately  thick. 

(d)  The  arch  should  be  flexible  and  without 
metal  shank  or  other  stiffening. 

(e)  It  should  have  eyelets  (not  hooks)  for  fas- 
tening, and  the  tongue  should  lie  smooth  under  the 
laces. 

(f )  The  shoe  should  reach  only  a  little  above 
the  ankle;  it  should  be  wide  across  the  ball  of  the 
foot  and  should  have  a  high  toe  cap. 

(g)  It  must  be  comforable,  neat  looking,  and 
light  in  weight. 

(h)   It  must  be  easily  put  on  and  removed. 

Civilian  Models. — The  styles  of  shoes  pur- 
chasable in  the  shops  are  practically  all  defective 
in  shape  and  unsuitable  for  marching.  The  "tooth- 
pick" type  and  even  broadtoed  models  produce  a 
forced  outward  angling  at  the  junction  of  the  great 
toe  with  the  main  portion  of  the  foot.  This  shifts 
the  axis  of  the  foot,  which  normally  should  be  direct- 
ly to  the  front  in  marching.  Shoes  ordinarily  pur- 
chased are  too  small  for  the  wearer,  either  in  length, 
in  breadth,  or  in  both  these  dimensions.  It  must 
be  remembered  that  the  soldier  is  obliged  to  carry 
a  load  of  clothing  and  equipment  amounting  to  at 
least  40  pounds.  Under  such  a  weight  the  foot,  if 
unconfined,  lengthens  and  broadens  to  a  surprising 


degree.  This  may  amount  to  more  than  -J  an  inch 
from  heel  to  toe  and  nearly  as  much  across  the  ball. 
It  is  thus  evident  that,  to  avoid  injury  in  marching, 
the  shoe  must  be  roomy  enough  to  allow  all  or  a  ma- 
jor part  of  this  normal  expansion. 

Supervision  in  Fitting. — Soldiers  cannot  be 
trusted  to  fit  themselves  with  marching  shoes,  as, 
through  ignorance  or  vanity  (or,  perhaps,  lack  of 
proper  size),  tight-fitting  footwear  will  usually  be 
chosen  or  accepted.  Thus  the  supervision  of  officers 
becomes  necessary. 

How  to  Fit  Shoes. — Feet  are  measured  and 
shoes  fitted  by  company  commanders  in  the  follow- 
ing manner:  The  soldier  stands  with  bared  foot 
upon  a  small,  graduated  measuring  board,  resting 
his  entire  weight  (augmented  by  a  40  pound  burden 
on  his  back)  upon  that  foot.  The  length  of  the  ex- 
panded foot  is  read  off  from  the  board  and  the  cir- 
cumference around  the  ball  is  taken  by  means  of  a 
tape  applied  at  the  base  of  the  toes.  An  approxi- 
mation to  the  correct  shoe  length  is  then  determined 
by  adding  2  to  the  scale  reading.  For  width,  the 
table  of  sizes  given  in  the  annual  price  list  of  cloth- 
ing, issued  by  the  Quartermaster  General,  should  be 
consulted.  For  example,  let  us  assume  that  a  foot 
measures  6i  on  the  scale  and  has  a  circumference  of 
9i  at  the  ball.  Size  8^  D  is  found  to  be  the  shoe 
which  would  approximate  a  fit;  if  this  is  not  quite 
correct,  others  will  be  tried  on  until  a  satisfactory 
fit  is  had.  With  each  trial  the  shoe  should  be  snugly 
laced  and  the  soldier  will  throw  his  augmented 
weight  upon  the  shod  foot.  The  company  com- 
mander personally  verifies  the  fit,  assuring  himself 
especially,  by  pressure  with  his  hand,  that  not  less 
than  f  inch  of  vacant  space  exists  in  front  of  the 


—55— 

great  toe  and  that  no  undue  pressure  or  wrinkling 
exists  over  the  ball  of  the  foot. 

Breaking  In. — New  shoes  should  be  adapted 
to  the  contours  of  the  foot  by  gradual  wear  and 
should  on  no  occasion  be  used  for  marching  until 
broken  in.  If  there  is  need  for  haste  in  the  process, 
this  may  be  accomplished  by  having  the  soldier 
stand  in  water  for  a  few  minutes  until  the  leather 
is  sodden.  He  should  then  walk  about  for  an  hour 
or  so  on  a  level  surface  letting  the  shoes  dry  on  his 
feet.  On  removal,  a  little  neat's-foot  oil  should  be 
rubbed  into  the  leather  to  prevent  hardening  and 
cracking.  Shoes  may  be  waterproofed  by  rubbing 
a  considerable  amount  of  this  oil  into  the  dry 
leather. 

It  is  believed  that  with  the  adoption  of  the  new 
shoe  and  its  complete  supply  to  the  army,  to  the 
exclusion  of  other  styles,  our  service  will  have  foot- 
wear superior  to  that  of  any  other  nation.  The 
average  American  has  a  foot  rendered  abnormal  by 
long  wear  of  shoes  of  bad  shape  or  improper  size. 
But,  taken  in  conjunction  with  the  oversight  in  fit- 
ting and  care  of  the  feet  now  rendered  obligatory,  we 
should  have  a  minimum  of  foot  troubles.  The  high 
boots  worn  by  German  and  Russian  foot  troops  fur- 
nish a  striking  contrast  to  our  own  shoes  in  appear- 
ance, comfort  and  efficiency.  That  men  can  march 
at  all  in  such  clumsy,  mis-shapen  footwear  as  that 
of  the  foreign  nations  cited  is  surprising.  The 
weight  of  such  boots  is  4  pounds,  which  is  twice  that 
of  our  shoes. 

Overshoes  are  desirable  for  garrison  wear,  but 
not  usually  practicable  in  field  service.  The  "arctic" 
type  is  the  only  one  officially  supplied. 


Lecture 


MILITARY  HYGIENE 

Camp  Sanitation 

Camps 

THERE  is  no  subject  of  more  vital  importance  in 
the  training  of  line  officers  than  military  hy- 
giene. This  applies  with  especial  force  to  the  military 
hygiene  of  field  service.  Why  is  this?  Because 
when  troops  are  in  garrison,  their  mode  of  life  ap- 
proximates in  hygienic  arrangements,  the  life  of  the 
better  class  of  the  civil  population.  Their  dwellings 
are  constructed  with  a  view  to  sanitary  require- 
ments. Their  exercises  and  habits  are  similarly 
governed.  Their  surroundings,  food  supply,  water 
supply  and  other  necessities  of  life  are  established, 
regulated  and  constantly  watched  by  highly  special- 
ized officers.  In  garrison  the  individual  line  officer 
must  concern  himself  with  the  habits  and  personal 
hygiene  of  his  men,  and  the  general  police  of  the 
post ;  but  very  rarely  is  it  necessary  for  him  to  con- 
cern himself  directly  with  the  sanitary  arrange- 
ments for  living  in  an  established  post.  Moreover 
in  garrison,  it  is  extremely  unusual  that  the  require- 
ments of  military  necessity  conflict  with  the  prime 
essentials  of  military  hygiene.  The  troops  of  garri- 
son life  are  ordinarily  disciplined  men,  who  have 
received  training  in  sanitary  matters;  whereas  in 
field  service  in  our  military  forces,  a  line  officer  of 
the  standing  army  is  very  frequently  placed  in  com- 
mand of  untrained  or  insufficiently  trained  troops, 
of  the  organized  militia  or  volunteers.  In  the  field, 
57 


—58— 

and  especially  in  active  service  the  situation  is  com- 
pletely reversed.  Life  in  the  field,  especially  where 
very  large  bodies  of  men  are  congregated,  offers 
many  problems  in  sanitary,  as  well  as  other  ar- 
rangements. When  white  men  are  assembled  in 
large  communities,  they  are  in  modern  life  accus- 
tomed to  systematic  arrangements  for  good,  and 
sufficient  supplies  of  food  and  water ;  for  systematic 
disposal  of  wastes,  and  all  other  sanitary  appliances 
of  like  character.  When  men  are  suddenly  congre- 
gated in  the  field,  their  officers  at  once  find  them- 
selves face  to  face  with  the  elementary  problems  of 
field  sanitation.  Very  often,  these  sanitary  prob- 
lems must  be  solved  by  the  line  officer  individually. 
At  times,  the  requirements  of  military  necessity 
may  compel  him  to  disregard  the  recommendations 
made  to  him  by  his  sanitary  officer  even  though  he 
himself  realizes  their  full  significance.  However, 
when  we  leave  out  of  the  question  the  factor  of  mili- 
tary necessity,  the  vital  fact  remains  that  sanitation 
in  the  field  depends  upon  the  line  officer  fully  as 
much  if  not  more  than  upon  the  medical  officer.  By 
the  line  officer  I  mean  the  company  or  detachment 
commander  fully  as  much,  if  not  more,  than  the 
regimental  or  division  commander.  This  statement 
will  admit  of  much  explanation  and  may  demand 
much  evidence  for  substantiation,  which  I  have  not 
the  opportunity  to  give  here.  I  will  merely  cite  the 
contrast  between  the  mobilization  camps  of  1898  and 
1916.  In  the  former  case,  the  line  officers  very  fre- 
quently did  not  realize  the  importance  of  camp  sani- 
tation; in  the  latter,  they  were  frequently  as  eager 
for  sanitary  conditions  as  the  medical  officers.  In 
this  connection,  I  will  read  the  following  extract 
from  a  press  dispatch,  dated  San  Antonio,  Texas, 
November  28,  1916. 


—59— 

"As  a  result  of  the  scientific  methods  adopted 
by  the  Medical  Corps  and  the  steps  taken  to  insure 
absolute  sanitation  in  border  camps  the  big  com- 
mand of  regulars  and  militia  has  set  a  new  health 
record.  From  May  1,  to  October  31,  there  were  only 
seventy-five  deaths  from  disease  in  the  force  of  more 
than  150,000  men,  and  of  this  small  number  only 
twenty-one  deaths  were  due  to  infectious  maladies. 

"Typhoid  fever  was  formerly  the  worst  scourge 
of  camp,  but  it  has  no  place  among  the  troops  along 
the  Mexican  border.  From  May  1,  to  October  18, 
only  twenty-one  cases  of  typhoid  developed  and  no 
deaths  resulted  from  the  disease.  All  of  these  cases 
were  among  the  National  Guard  organizations, 
where  in  some  instances  the  men  were  not  inoculated 
with  typhoid  serum  until  after  regiments  had  come 
to  the  border.  There  was  not  a  single  case  among 
the  42,000  troops  of  the  regular  army  engaged  in 
patrol  duty  and  stationed  in  Mexico  with  General 
Pershing's  command. 

"In  Spanish-American  war  days — over  a  period 
of  eight  months  in  1898 — among  147,000  regulars 
and  volunteers,  the  typhoid  epidemic  reached  the 
enormous  total  of  21,000  cases  and  there  were  2,192 
deaths  from  the  disease/' 

Why  is  it  that  administrative  officers  now  lend 
a  ready  ear  to  the  demands  of  field  sanitation  ?  This 
question  is  answered  in  part  by  the  foregoing  quo- 
tation. It  will  be  emphasized  by  a  statement  of  the 
statistics  of  the  deaths  in  battle  or  deaths  as  a  result 
of  battle  wounds  and  deaths  from  disease  in  a  few 
modern  wars. 


—60— 
Mexican  War  1846-47 

American  Regulars  Only 

Died  from  sickness 22  per  cent. 

Invalided  from  sickness,  additional  to  pre- 
ceding   __. 14  per  cent. 

Killed  in  battle  or  died  from  wounds  __  5  per  cent. 

American  Civil  War 

Killed  in  battle  or  died  from  wounds 93,967 

Died  of  disase 186,216 

Thus  two  deaths  are  recorded  for  disease  to  one  for 
battle   casualty. 

Crimean  War  1854-56 

French    forces    310,000 

Died  from   disease    70,000 

Invalided    65,000 

Battle  deaths   7,500 

Spanish- American  War 

Deaths  from  battle  in  all  camps  and  fields 293 

Deaths  from  disease  in  all  camps  and  fields 3,681 

This  is  one  death  in  battle  to  12.5  from  disease. 

War  Between  China  and  Japan  1894-95 

Japanese  forces  in  the  field   227,000 

Deaths  from  battle    1,311 

Deaths  from   disease    15,850 

The  ratio  here  is  one  to  twelve. 

That  the  Japanese  were  taught  a  lesson  by  this 
record  is  shown  in  the  following  war. 

Russo-Japanese  War  1904-05 
Total  estimated  Japanese  strength  in  field  of 

operations    700,000 

Deaths   from   battle    58,887 

Deaths    from    disease    27,158 

In  the  same  war,  Havard  estimates  the  Rus- 
sian casualties  to  have  been  approximately  the  fol- 
lowing : 

Deaths   from   battle    47,608 

Deaths  from  disease   27,830 


—61— 

Thus  it  will  be  seen  that  even  in  modern  wars 
until  the  last  decade  the  deaths  from  sickness  have 
totaled  a  larger  figure  than  the  deaths  from  battle. 
The  non-effectives  from  sickness  are  an  even  more 
vital  military  factor  in  war  than  the  deaths,  because 
of  the  fact  that  ineffectives  from  sickness  always 
number  many  times  more  than  the  losses  by  death 
from  sickness.  For  it  may  be  safely  assumed  that  if 
a  command  has  in  a  certain  period  200  deaths  from 
disease,  its  constant  non-effective  rate  from  sick- 
ness will  be  may  times  that  number  for  the  same 
period. 

Before  proceeding  further,  the  question  arises : 
"What  are  the  principle  camp  diseases  which  pro- 
duce the  frightful  mortality  and  morbidity  of  mili- 
tary campaigns?"  The  question  is  pertinent,  be- 
cause we  are  far  better  able  to  cope  with  an  enemy 
known,  than  one  concealed. 

In  the  European  Wars  of  the  18th  Century  and 
Napoleonic  era,  typhus  fever  was  an  ubiquitous 
scourge.  This  disease  has  never  been  absent  in  any 
of  the  prolonged  wars  of  Europe  so  far  as  we  have 
record.  It  will  be  remembered  by  you  that  this 
pestilence  has  prevailed  in  epidemic  form  on  the 
Eastern  and  Serbian  fronts  during  the  present  Eu- 
ropean struggle.  The  same  disease  is  present  in 
Mexico  today,  and  must  be  reckoned  with  by  any 
troops  who  wage  war  in  the  Southern  Republic. 
Typhus  fever  must  not  be  confused  in  your  minds 
with  typhoid  fever,  which  it  resembles  in  some  re- 
spects. One  marked  difference  in  the  two  diseases, 
and  the  only  one  which  here  concerns  us  is  the 
metfrod  of  transmission;  typhus  fever  being  con- 
veyed by  the  bites  of  the  body  louse,  whereas  typhoid 
fever  as  you  well  know  is  a  disease  ordinarily  trans- 
mitted by  infected  water  or  food  supplies.  This 


—62— 

brings  us  to  the  triad  of  cholera,  typhoid  fever, 
dysenteries  and  allied  camp  diarrheas,  which  are 
often  termed  the  water-borne  or  fly-borne  diseases 
from  the  importance  of  these  two  factors  in  their 
causation.  In  American  military  campaigns  these 
have  caused  the  greatest  number  of  losses  from 
disease.  Other  diseases  to  be  dreaded  in  military 
campaigns  on  this  continent  are  the  mosquito  borne 
malarial  fevers ;  yellow  fever  and  dengue.  Vener- 
eal and  respiratory  diseases  while  not  especially 
associated  with  camp  life  in  distinction  from  garri- 
son life  are  always  factors  in  the  sick  rate  of  ar- 
mies. 

We  have  briefly  discussed  the  reasons  for  the 
importance  of  field  sanitation,  and  have  enumerated 
a  few  of  the  diseases  which  have  decimated  the  ar- 
mies of  all  history.  Before  passing  on  to  the  details 
of  this  subject  I  shall  pause  to  emphasize  again  the 
important  and  responsible  role  which  the  line  officer 
holds  in  relation  to  this  subject.  The  supreme  com- 
mander of  the  nation's  armies,  who  would  permit  his 
subordinates  to  neglect  field  sanitation  of  campaign- 
ing troops  could  not  with  our  present  viewpoint  be 
considered  a  wholly  competent  commander,  no  mat- 
ter what  other  military  qualifications  he  might  pos- 
sess. In  no  less  degree,  the  efficiency  of  the  division 
or  regimental  commander  who  would  slight  the  sani- 
tary care  of  his  troops,  would  be  diminished ;  and  his 
chances  of  military  success  would  be  equally  cur- 
tailed. Finally  the  company  or  detachment  com- 
mander upon  whom  after  all  depends  the  execution 
of  the  prime  requisites  of  sanitation,  who,  neglects 
or  disregards  the  sanitary  regimen  of  his  command, 
is  morally  responsible  for  the  deaths  and  illness  from 
preventable  diseases  which  occur  among  his  men ;  is 
morally  responsible  to  his  country  for  the  ineffec- 


—63— 

tives  from  the  same  sources  in.  his  command ;  and  is 
directly  and  judicially  responsible  to  his  higher  com- 
manders for  failure  to  enforce  the  well  known  laws 
of  camp  sanitation  or  to  adopt  the  proper  and  prac- 
ticable recommendations  of  his  medical  officers.  The 
importance  of  your  future  position,  gentlemen,  as 
executive  officers  in  these  matters,  impresses  me 
strongly  with  my  duty  to  you  in  this  regard.  Do 
not,  as  you  go  out  in  the  service,  think  lightly  of  the 
sanitation  of  your  command.  Do  not  neglect  it  or 
disregard  the  advice  of  your  surgeon.  Do  not  permit 
petty  personal  or  official  differences  to  influence  you 
in  the  matter  of  the  care  of  your  command  and  its 
protection  from  disease  and  death.  Do  riot  make  the 
life  of  your  sanitary  inspector  a  burden  by  regarding 
him  as  an  iniquitous  pest  when  he  is  in  fact  perform- 
ing his  proper  military  duty.  Finally,  do  not  modi- 
fy or  shelve  or  otherwise  fail  to  take  proper  action 
on  his  sanitary  recommendations,  unless  you  are 
certain  that  the  department  will  approve  of  your 
action  in  stacking  up  your  sanitary  knowledge 
against  that  of  the  medical  officer;  or  that  the  law 
of  military  necessity  compels  you  to  disregard  his 
advice ;  or  finally  that  his  recommendations  are 
wholly  impracticable.  In  the  last  event,  you  may 
save  yourself  much  difficulty  by  referring  the  matter 
to  higher  authority  with  your  indorsed  expression 
of  opinion. 

Camp  Sites 

Field  Service  Regulations  has  the  following 
sanitary  requirements  for  camp  sites  and  other  sani- 
tary arrangements  of  camps. 

Par.  236.  The  ground  should  be  easily  drained, 
naturally  healthful,  and  large  enough  for  depots, 
corrals,  hospitals,  etc.,  and  the  encampment  of  troops 


—64— 

without  crowding,  and  with  ample  space  for  exercise 
and  instruction. 

The  water  supply  should  be  excellent  and  abun- 
dant and  not  liable  to  contamination  from  any 
source. 

Par.  238.  Selection  of  Site.— There  is  often 
little  choice  in  the  selection  of  camp  sites  in  war. 
Troops  may  have  to  camp  many  nights  on  objection- 
able ground.  Nevertheless,  sanitary  considerations 
are  given  all  the  weight  possible  consistent  with  the 
tactical  requirements. 

When  tactical  questions  are  not  involved,  and 
especially  when  the  camp  is  to  be  occupied  for  some 
time,  great  care  is  exercised  in  selecting  the  site. 
Through  no  fault  of  their  own,  troops  occupying  an 
unsanitary  site  may  suffer  greater  losses  than  in  the 
battles  of  a  long  caippaign.  A  medical  officer  assists 
in  the  selection  of  camp  sites. 

The  selection  of  camp  sites  while  on  the  march 
or  during  active  operations  is  governed  by  the  fol- 
lowing conditions: 

1.  The  ground  should  accommodate  the  com- 
mand with  as  little  crowding  as  possible,  be  easily 
drained,  and  have  no  stagnant  water  within  300 
yards. 

2.  The  water  supply  should  be  sufficient,  pure, 
and  accessible. 

3.  There  should  be  good  roads  to  the  camp  and 
•ood  interior  communication. 


. 


4.  Wood,  grass,  forage,  and  supplies  must  be  at 
hand  or  obtainable. 

Closely  cropped  turf  with  sandy  or  gravelly 
subsoil  is  best;  high  banks  of  rivers  are  suitable, 
provided  no  marshes  are  near. 


—65— 

In  hot  summer  months,  the  ground  selected 
should  be  high,  free  from  underbrush,  and  shaded 
with  trees  if  possible. 

In  cold  weather,  ground  sloping  to  the  south, 
with  woods  to  break  the  north  winds,  is  desirable. 

Old  camp  grounds  and  the  vicinity  of  ceme- 
teries are  undesirable.  Marshy  ground  and  stag- 
nant water  are  objectionable  on  account  of  the  damp 
atmosphere  and  the  annoyance  and  infection  from 
mosquitos.  Ground  near  the  foot  of  a  hill  range 
generally  has  a  damp  subsoil  and  remains  muddy  for 
a  long  time.  Thick  forests,  dense  vegetation,  made 
ground,  alluvial  soil,  punch-bowl  depressions,  in- 
closed ravines,  and  dry  beds  of  streams  are  unfavor- 
able. 

Camp  sites  should  be  selected  so  that  troops  of 
one  unit  need  not  pass  through  the  camp  grounds  of 
another. 

As  a  protection  against  epidemics,  temporary 
camp  sites  in  the  theatre  of  operations  should  be 
changed  every  two  or  three  weeks. 

Par.  240.  Establishing  the  Camp. — Camp  is 
established  pursuant  to  the  halt  order.  This  order 
provides  for  the  outpost,  if  necessary,  and  gives 
instructions  for  the  encampment  of  the  main  body. 
When  practicable,  large  commands  are  encamped 
by  brigades. 

The  camping  ground  may  be  selected  by  the 
supreme  commander,  but  in  large  commands  is  gen- 
erally chosen  by  a  staff  officer  sent  forward  for  that 
purpose.  This  officer,  with  a  representative  from 
each  brigade  and  regiment  and  a  medical  officer, 
precedes  the  command,  selects  the  camping  ground, 
assigns  sections  thereof  to  the  larger  fractions  of 
the  command,  and  causes  them  to  be  conducted  to 
their  respective  sections  on  arrival.  He  also  desig- 


—66— 

nates  the  place  for  obtaining  drinking  and  cooking 
water,  for  watering  animals,  for  bathing,  and  for 
washing  clothing,  in  the  order  named,  from  up- 
stream down. 

On  the  arrival  of  the  troops,  guards  are  posted 
to  enforce  proper  use  of  the  water  supply;  the  in- 
terior camp  guards  proceed  to  their  places,  and 
after  posting  sentinels,  pitch  their  tents.  The  re- 
maining troops  pitch  tents  and  secure  animals  and 
equipment;  kitchens  are  established  and  details 
made  to  procure  fuel,  water,  forage,  etc.,  and  to 
prepare  latrines  and  kitchen  pits ;  if  necessary,  tents, 
company  streets,  and  picket  lines  are  ditched. 

In  the  presence  of  the  enemy,  places  of  assembly 
for  the  troops  are  designated  and  directions  given 
for  their  conduct  in  case  of  attack.  Lines  of  infor- 
mation are  established  with  the  outpost. 

Par.  241.  Billeting. — Unless  the  force  is  small, 
shelter  of  this  character  is  usually  inadequate,  and 
some  of  the  troops  must  use  shelter  tents  or 
bivouac.  Villages  and  large  farms  often  afford  faci- 
lities, such  as  wells  and  forage,  which  contribute  to 
the  comfort  of  the  troops;  it  is  therefore  advanta- 
geous to  camp  or  bivouac  near  them. 

Par.  232.  In  enemy  territory  public  and  private 
buildings  may  be  used  to  shelter  troops  and  for 
other  military  purposes;  but  for  sanitary  reasons 
troops  are  seldom  quartered  in  private  buildings. 

Par.  242.  Bivouacs. — On  marches  or  in  the 
presence  of  the  enemy  troops  are  frequently  forced 
to  bivouac  on  account  of  lack  of  suitable  ground  or 
for  tactical  reasons.  On  the  other  hand,  in  fine 
weather,  in  midsummer,  or  in  the  dry  season  in  the 
tropics,  the  troops  may  bivouac  from  choice. 

From  the  tactical  point  of  view,  bivouacs  are 
very  convenient,  but  for  sanitary  reasons  they  are 


—67— 

resorted  to,  as  a  rule,  only  when  necessary.  The 
general  principles  governing  the  selection  of  camp 
sites  apply  to  bivouacs.  The  ground  should  be  dry 
and  protected  against  sun  and  wind.  Light  woods 
are  nearly  always  good  sites  for  infantry  bivouacs, 
on  account  of  the  shelter  and  material  available. 

Par.  244.  Shelter  During  Sieges. — To  guard 
against  danger  from  epidemics  in  the  necessarily 
crowded  camps  or  cantonments  of  the  besiegers,  the 
most  careful  attention  is  paid  to  the  water  supply 
and  sanitation. 

Par.  245.  Care  of  Troops. — Lack  of  sufficient 
rest  renders  troops  unfit  for  hard  work  and  dimin- 
ishes their  power  of  resisting  disease.  Therefore 
commanders  should  secure  for  the  troops,  whenever 
possible,  their  accustomed  rest. 

The  rules  of  sanitation  are  enforced. 

Men  should  not  lie  on  camp  ground.  In  tem- 
porary camps  and  in  bivouac  they  raise  their  beds 
if  suitable  material,  such  as  straw,  leaves,  or  boughs 
can  be  obtained,  or  use  their  ponchos  or  slickers.  In 
cold  weather  and  when  fuel  is  plentiful  the  ground 
may  be  warmed  by  fires,  the  men  making  their  beds 
after  raking  away  the  ashes. 

0  When  troops  are  to  remain  in  camp  for  some 
time  all  underbrush  is  cleared  away  and  the  camp 
made  as  comfortable  as  possible.  Watering  troughs, 
shelter  in  cold  weather,  and  shade  in  hot,  are  pro- 
vided for  the  animals,  if  practicable. 

In  camps  of  some  duration  guard  and  other 
routine  duties  follow  closely  the  custom  in  garrison. 
The  watering,  feeding,  and  grooming  of  animals  take 
place  at  regular  hours  and  under  the  supervision  of 
officers. 

The  camp  is  policed  daily  after  breakfast  and 
all  refuse  matter  burned. 


—68— 

Tent  walls  are  raised  and  the  bedding  and  cloth- 
ing aired  daily,  weather  permitting. 

Arms  and  personal  equipment  are  kept  in  the 
tents  of  the  men.  In  the  cavalry,  horse  equipments 
are  usually  kept  in  the  tents,  but  in  camps  of  some 
duration  they  may  be  placed  on  racks  outside  and 
covered  with  slickers.  In  the  artillery,  horse  equip- 
ments and  harness  are  placed  on  the  poles  of  the 
carriages  and  covered  with  paulins. 

The  water  supply  is  carefully  guarded.  When 
several  commands  are  encamped  along  the  same 
stream  this  matter  is  regulated  by  the  senior  officer. 
If  the  stream  is  small,  the  water  supply  may  be 
increased  by  building  dams.  Small  springs  may 
be  dug  out  and  lined  with  stone,  brick,  or  empty 
barrels.  Surface  drainage  is  kept  off  by  a  curb  of 
clay. 

When  sterilized  water  is  not  provided,  or  when 
there  is  doubt  as  to  the  purity  of  the  water,  it  is 
boiled  20  minutes,  then  cooled  and  aerated. 

Par  246  "*  *********** 
From  latrines  50  yards  to  nearest  occupied  tent; 
but,  when  a  smaller  camp  is  desired,  the  space  be- 
tween company  latrines  and  the  men's  tents  may  be 
used  to  park  carriages  and  animals.  Latrine  seats 
are  provided  at  the  rate  of  one  seat  to  about  every 
ten  men ;  shower  heads  at  one  to  every  50  to  100  men, 
depending  upon  water  pressure." 

Thus  you  see,  the  prime  essentials  of  camp  sites 
are  definitely  prescribed  in  this  manual,  which  is 
primarily  compiled  for  the  use  of  combatant  troops. 
I  have  quoted  them  in  detail,  because  your  attention 
is  thus  directed  to  the  fact  that  you  always  have 
at  hand  a  guide  in  these  matters;  and  further  be- 
cause you  cannot  go  far  wrong  in  camp  sanitation 
if  you  obey  these  simple  rules.  The  War  Depart- 


—69— 

ment  has  under  date  of  September  11,  1916,  seen 
fit  to  issue  a  General  Order  (No.  45)  governing  sani- 
tary regulation  of  camps.  This  order  should  be  in 
the  possession  of  every  officer.  I  shall  quote  this 
frequently  in  the  subsequent  discussion. 

A  few  additional  remarks  will  not  be  useless  to 
you.  Whenever  you  are  required  to  select  a  camp 
site,  it  is  important  to  consider  the  conditions  in  the 
neighborhood  of  the  proposed  camp.  Other  things 
being  equal  it  is  always  better  from  a  sanitary  stand- 
point to  place  a  camp  away  from  fixed  habitations 
such  as  villages  or  towns  than  in  or  near  such  places. 
As  a  general  principle  also  it  is  wiser  to  place  a  camp 
above  stream  in  preference  to  down  stream  from  a 
town  when  the  camp  site  is  to  be  along  a  water 
course.  If  you  are  sent  ahead  of  a  marching  com- 
mand to  select  a  site,  do  not  regard  your  work  as 
satisfactorily  done  until  you  have  endeavored  to 
ascertain  some  information  concerning  prevailing 
diseases  among  the  inhabitants  and  domestic  ani- 
mals of  the  locality.  If  any  one  of  the  serious  water 
borne  diseases,  typhoid,  cholera,  or  dysentery  is  pre- 
sent ;  if  typhus  fever  or  other  serious  contagious  di- 
sease is  present;  if  a  serious  epidemic  is  present 
among  horses  or  cattle;  the  community  should  be 
avoided  even  for  a  temporary  camp  site.  In  the  in- 
stance of  a  temporary  camp  site  for  a  small  body  of 
men,  it  is  often  sufficient  when  you  have  selected  a 
location  which  appears  to  meet  all  requirements,  that 
you  cause  inquiry  to  be  made  at  all  nearby  houses,  or 
to  the  village  doctor  or  some  other  well  informed  per- 
son in  the  community  as  to  the  presence  of  conta- 
gious or  communicable  disease.  In  selecting  camp 
sites  for  large  bodies  of  men,  a  medical  officer  will 
assist  his  commander  in  this  matter.  His  recom- 
mendations should  in  all  cases  be  given  due  consider- 
ation. 


—70— 

The  following  details  are  to  be  kept  in  view  in 
considering  the  desirability  of  a  camp  site  from  a 
hygienic  viewpoint. 

1.  The   site  must  be  sufficiently  extensive   to 
accommodate  the  entire  command  without  crowding. 
For  a  bivouac  or  very  temporary  camp,  this  feature 
is  of  much  less  moment  than  in  camps  of  longer  dur- 
ation, because  in  the  latter  it  is  a  well  established 
law  that  the  more  densely  men  are  concentrated,  the 
more  liable  they  are  to  the  occurrence  of  communic- 
able diseases.     Havard   considers   that   a   brigade 
should  be  the  maximum  for  one  camp. 

2.  The  site  should  be  high  enough  to  secure  a 
dry  camp.     An  especially  desirable  site  is  a  plateau 
or  ridge  with  a  gentle  slope  to  secure  natural  drain- 
age; but  a  sharp  slope  from  one  camp  to  the  next 
is  most  undesirable  for  the  reason  that  the  pollution 
of  one  camp  drains  into  the  next.     In  cold  weather, 
a  slope  to  the  south  with  woods  or  other  obstruction 
to  protect  from  the   winds  is  desirable.     In  summer 
or  in  tropical  campaigns  high  grounds,  breeze  swept 
and  preferably  shaded  by  trees  are  more  agreeable 
camp  sites.    Grounds  at  the  foot  of  ravines  are  sub- 
ject to  flooding  and  are  exceedingly  unhealthful  and 
unsatisfactory. 

3.  Camps  should  not  be  placed  in  the  vicinity  of 
marshes  or  stagnant  waters.     These  favor  the  pre- 
valence of  mosquitos,  with  their  attendant  mosquito 
borne  diseases  as  well  as  their  constant  annoyance. 
These  localities  also  favor  rheumatic  affections,  tu- 
berculosis and  many  similar  affections.     A  camp  site 
must  be  dry,  well  cleared  and  well  swept  by  the  sun 
and  prevailing  breeze.     A  camp  site  which  has  been 
priorly   used  for  the   same   purpose   within   three 
months  should  be  avoided. 


-71- 

4.  The  best  soil  for  camp  sites  is  a  gravel  or 
sand-gravel  soil  which  readily  permits  rain  water 
to  sink  through  it.     On  the  contrary  a  clay  or  clayey 
soil  is  the    least  satisfactory.     The  character  of  he 
soil  and  subsoil  has  much  to  do  with  the  comfort  and 
health  of  a  permanent  camp,  and  when  there  is  op- 
portunity to  choose,  this  factor  deserves  rememb- 
rance.    It  is  quite  important  that  the  ground  water 
should  not  be  nearer  the  surface  than  eight  feet. 
Twelve  feet  is  a  safer  figure.     A  pure  sand  soil  is 
disadvantageous  on  account  of, the  glare;  the  con- 
stant blowing  about  of  the  surface  sand;  and  the 
mechanical  difficulties  of  camping  in  sand. 

5.  The  presence  of  occasional  trees  and  shrubs  J 
is  desirable  because  of  the  protection  during  the 
heat  of  the  day,  the  lessening  of  ground  dampness, 
and  the  restful  effect  upon  the  eyes.     Heavy  foliage 
or  underbrush  is  unhealthful  and  undesirable.     A 
grass  covered  soil  is  a  blessing  to  a  camp  and  should 
be  preserved  as  long  as  possible. 

Water 

Nothing  is  ,of  greater  importance  in  the  selec- 
tion of  a  camp  site  than  an  adequate  supply  of 
potable  water. 

What  is  an  adequate  supply  of  water?  Mani- 
festly a  temporary  camp  does  not  demand  the  same 
amount  as  a  prolonged  camp  with  its  shower  baths, 
laundering  facilities,  and  even  disposal  of  sewage  by 
a  plumbing  system.  Again  a  mounted  command  re- 
quires a  much  greater  supply  than  a  dismounted 
one.  You  will  find  on  p.  207,  F.S.R.  the  following 
useful  data  on  daily  water  requirements. 

Water. — Approximate  daily  requirements: 

1  gallon  per  man  on  march. 

5  galons  per  man  in  camp  . 

6  to  10  galons  per  animal  on  march  and  camp. 


—72— 

(The  above  figures  apply  to  water  taken  from 
streams,  where  animals  are  watered  at  the  streams, 
and  cooking  water  carried.  In  estimating  the  daily 
supply  for  permanent  or  semi-permanent  camps, 
where  water  is  piped  to  kitchens,  bath  houses,  etc., 
the  requirements  will  be  25  to  30  gallons  per  man 
and  10  to  15  gallons  per  animal,  depending  on  cli- 
matic conditions.) 

What  is  potable  water  ?  The  potability  of  water 
supply  should  always  be  referred  for  decision  to  a 
medical  officer,  when  present  with  the  command. 
In  case  of  doubt  or  suspicion  as  to  the  safety  of  a 
water  supply,  you  are  directed  by  F.S.R.  to  require 
that  the  water  supply  for  your  command  be  boiled 
for  twenty  minutes. 

Water  supplies  are  derived  from  three  sources ; 
the  sky ;  the  surface  of  the  earth ;  the  depths  of  the 
earth.  Rain  water  properly  collected  in  clean,  im- 
permeable cisterns  is  potable  and  above  suspicion, 
but  is  rarely  available  for  even  a  small  body  of 
troops.  Surface  waters  from  rivers,  streams,  lakes 
and  ponds  may  be  pure  or  contaminated  according 
to  circumstances.  The  chief  factor  in  the  matter  is 
human  pollution.  A  river  or  stream  flowing  thru  a 
sparsely  inhabited  country  is  usually  a  reasonably 
safe  water  provided  there  is  no  pollution  within  sev- 
eral miles  of  camp.  A  flowing  body  of  water  is  self 
purifying  by  dilution ;  by  sedimentation ;  by  effect  of 
sunlight;  by  the  activities  of  animal  and  vegetable 
life.  Factors  to  be  considered  are  size  and  rate  of 
flow  of  stream,  and  amount  and  proximity  of  pollu- 
tion. A  river  or  stream  even  100  miles  below  a 
large  community  in  which  a  water  borne  disease  is 
prevalent  is  an  unsafe  water  supply.  A  camp  site 
on  a  very  large  lake,  many  miles  removed  from  a 
town  usually  affords  a  safe  water  supply,  provided 


—73— 

the  camp  is  not  permitted  to  pollute  its  own  water 
supply.  Small  lakes  and  ponds  in  thickly  populated 
regions  or  near  human  dwellings  are  a  dangerous 
water  supply.  Springs  are  really  out-croppings  of 
subsoil  water  and  must  be  considered  with  reference 
to  their  source  and  liability  to  pollution.  This  may 
often  be  approximately  determined  from  the  surface 
configuration.  More  accurately  by  color  or  bacter- 
ial tests. 

Sub-soil  water  supplies  are  generally  classed  for 
purposes  of  sanitarians  as  coming  from  deep  or  shal- 
low wells.  The  distinction  lies  not  in  any  mathe- 
matical terms  but  in  the  fact  that  deep  wells  pass 
thru  one  or  more  impermeable  layers  of  the  earth's 
surface,  whereas  shallow  wells  do  not.  As  you  pro- 
bably know,  a  layer  of  water  is  encountered  a  few 
feet  below  the  earth's  surface.  The  depth  varies 
greatly  in  different  localities  from  a  few  inches  to 
many  feet.  Similarly  the  height  of  this  ground 
water  varies  greatly  in  different  localities.  This  is 
called  subsoil  water  or  ground  water  and  is  the  ac- 
cumulated water  from  surface  drainage  of  what- 
ever description,  which  is  thus  held  at  this  level  by 
reason  of  a  supporting  layer  of  the  earth's  surface 
which  is  relatively  or  wholly  impermeable.  Any 
well  which  does  not  penetrate  at  least  one  imper- 
meable layer  must  then  of  necessity  draw  upon  this 
subsoil  or  ground  water  for  supply.  You  will  readi- 
ly understand  then  why  it  is  that  in  thickly  popu- 
lated communities  we  interdict  the  shallow  well. 
You  will  readily  see  that  such  water  supplies  in 
thickly  populated  places  will  receive  constantly  pol- 
lution of  every  character;  and  even  in  sparsely  set- 
tled places  be  liable  to  sufficient  contamination  to  be 
viewed  with  suspicion. 


—74— 

That  is  the  point  I  desire  to  emphasize.  Shal- 
low wells  are  always  suspicious  water  supplies.  It 
would  be  suicidal  for  large  bodies  of  troops  to  obtain 
their  water  supply  from  shallow  or  dry  wells  on  or 
very  near  a  camp  site  of  any  but  the  briefest  dura- 
tion. Small  bodies  of  men  may  use  water  supplies 
from  shallow  wells,  when  such  have  been  carefully 
examined,  and  sources  of  pollution  excluded.  In 
this  connection  two  phases  of  military  field  life  must 
be  considered.  Troops  permanently  or  semi-perma- 
nently  encamped  should  not  use  shallow  wells  for 
water  supplies  unless  these  supplies  are  treated  as 
suspicious  water  supplies  and  are  kept  under  con- 
stant medical  surveillance.  Troops  on  the  march  or 
when  campaigning  may  be  obliged  to  use  water  from 
these  sources.  In  such  cases,  how  would  you  as  an 
organization  commander  determine  the  probability 
of  the  purity  of  such  wells  ?  In  the  first  place,  you 
must  examine  the  surface  area  drained  directly  by 
the  well  in  question.  This  area  is  a  circle  whose 
radius  is  four  times  the  depth  of  the  well.  This 
figure  is  merely  approximate.  Contamination  from 
surface  pollution  may  of  course  proceed  a  much 
greater  distance.  But  in  this  special  area  no  source 
of  pollution  is  permissible.  Such  sources  may  be 
privies,  cess-pools,  pig-styes,  manure  piles,  cattle 
sheds,  stables  and  in  fact  any  manifest  organic  pol- 
lution. When  you  come  to  examine  the  wells  of 
American  villages  and  agricultural  communities  by 
this  simple  test,  you  will  be  surprised  to  find  how 
many  of  these  derive  their  water  directly  from  such 
filthy  sources.  The  second  test  is  the  position  of 
the  well  with  reference  to  the  slope  of  the  land. 
Land  slope  may  or  may  not  indicate  the  current  of 
ground  water  depending  entirely  upon  the  geology  of 
the  locality.  On  the  other  hand,  a  well  dug  on  the 


—75— 

mid  slope  of  a  hill,  whose  summit  is  crowned  with 
a  privy  would  obviously  be  an  unsafe  water  supply. 
The  third  test  for  you  to  make  is  valuable  in 
proportion  to  your  energy  in  its  prosecution  ajid  the 
intelligence  and  honesty  of  the  response.  Make  in- 
quiries among  all  households  in  the  vicinity  who  are 
using  or  have  used  this  well  for  a  drinking  supply. 
What  illness  have  they  had  in  the  past  two  years? 
If  typhoid,  dysentery,  diarrheas  or  other  water 
borne  diseases,  this  water  supply  is  highly  suspi- 
cious and  must  be  boiled  before  use  for  drinking.  I 
have  outlined  briefly  the  means  whereby  you  can 
judge  roughly  of  the  purity  of  shallow  well-water. 
Do  not  take  upon  yourself  the  responsibility  of  pass- 
ing upon  such  supply  if  you  have  a  medical  officer  on 
whom  to  bestow  this,  his  proper  responsibility.  In 
the  absence  of  a  medical  advisor,  apply  the  foregoing 
tests,  exercising  such  judgment  as  your  experience 
formulates.  In  case  of  doubt,  always  order  water 
supplies  to  be  purified.  So  doing  you  free  your  con- 
science from  the  possibility  of  having  illness  or  death 
of  your  men  placed  upon  it.  Deep  wells  penetrate  at 
least  one  impermeable  layer  and  if  properly  con- 
structed are  usually  safe  for  drinking.  Havard 
says,  "A  well  to  be  above  suspicion,  must  comply  to 
the  following  requirements;  it  should  traverse  the 
entire  aqueous  stratum  and  extend  to  the  subjacent 
impervious  clay  or  rock ;  it  should  be  lined  through- 
out or  at  least  above  the  water  with  a  well  construct- 
ed masonry  wall  vaulted  at  top  with  manhole  in  cen- 
ter, and  thoroughly  cemented  inside."  The  safest 
rule  in  prolonged  camps  is  to  require  that  a  compe- 
tent chemical  and  bacteriological  examination  of  the 
water  supply  of  troops  be  made  at  frequent  inter- 
vals. 


— 7G— 
Food 

Army  Regulations  are  now  quite  brief  in  pre- 
scribing the  field  ration  as  follows : 

"The  field  ration  is  the  ration  prescribed  in 
orders  by  the  commander  of  the  field  forces.  It  con- 
sists of  the  reserve  ration  in  whole  or  in  part,  sup- 
plemented by  articles  of  food  requisitioned  or  pur- 
chased locally,  or  shipped  from  the  rear,  provided 
such  supplements  or  substitutes  correspond  gener- 
ally with  the  component  articles  or  substitutive  equi- 
valents of  the  garrison  ration/' 

RESERVE  RATION 

Bacon    12  ounces 

or  meat,  canned 16 

Hard  bread   16 

Coffee,  roasted  and  ground 1.12 

Sugar    2.4 

Salt 0.16 

I  shall  not  enter  into  an  orderly  discussion  of 
the  relative  values  of  different  articles  of  food ;  but 
confine  myself  to  a  few  remarks  which  appear  to  me 
as  practicable. 

There  are  five  essential  elements  in  food  supply 
as  follows : 

1.  Proteids;  examples  of  this  class  are  J"  flesh  of  animals 

Function  to  replace  tissue  loss.    %  |  animal  products 

2.  Fats;  function  to  produce  body  heat. 

3.  Carbohydrates;  examples,  sugars,  starches,  vegetable 

products. 

Function  to  produce  energy. 

4.  Salts  and  Extractives,  obtained       f  fruits 

chiefly  from        •  -j  vegetables 

[  flavoring  agents 
Function — chemical  and  biologic  adjustment. 

5.  Water. 

All  of  these  elements  must  be  represented  in 
definite  ratio  in  a  diet  on  which  human  beings  are  to 
subsist  for  any  prolonged  period.  Failure  to  fur- 
nish the  minimum  required  amount  of  any  one  of 
these  elements  will  result  in  disease  production. 


77 

Some  ofthe  great  scourges  of  the  world  have  re- 
sulted from  disregard  of  this  law  of  nature,  among 
them  scurvy ;  beriberi ;  pellagra  (probably)  ;  sprue 
(probably)  ;  rickets.  *  These  are  well  recognized  di- 
sease entities,  in  addition  to  which  are  to  be  remem- 
bered the  countless  less  definite  evidences  of  mal-nu- 
trition  seen  in  persons  who  are  deprived  of  a  bal- 
anced diet.  A  dietary  then  must  not  only  be  suffi- 
cient in  amount,  but  characterized  by  sufficient  var- 
iety. Of  the  five  elements  of  diet  which  you  as  an 
organization  commander  must  always  be  on  your 
guard  to  remember  in  the  company  ration,  No.  4, 
listed  as  salts  and  extractives  and  obtainable  chiefly 
from  fruits  and  green  vegetables,  is  the  one  which  is 
most  frequently  neglected  with  unfavorable  results. 
Remember,  gentlemen,  that  a  diet  containing  all  of 
these  elements  except  element  No.  4  will  not  be  made 
complete  for  subsistence  by  the  addition  of  canned 
foods.  The  reason  of  this  is  that  the  process  of 
canning  requires  a  very  high  degree  of  heat,  which 
destroys  a  certain  element  in  the  food.  This  is 
called,  "vitamin."  Its  prolonged  deprivation  is  very 
probably  the  causative  agent  in  three  of  the  world's 
great  plagues;  Beri-beri,  pellagra  and  sprue.  Re- 
member then,  that  a  varied  diet  is  equally  as  neces- 
sary as  a  liberal  one,  and  that  fresh  or  dried  fruits, 
and  green  vegetables,  potatoes  and  other  articles 
containing  the  essential  salts  or  vitamines  are  neces- 
sary for  an  adequate  diet. 

Concerning  the  amount  of  food  necessary  for 
the  subsistence  of  your  men,  you  will  quickly  learn 
when  you  begin  to  handle  a  company  mess.  Men 
marching  or  campaigning  in  a  cold  or  stimulating 
climate  may  be  safely  given  a  very  liberal  ration. 
On  the  contrary,  men  in  garrison  or  prolonged  camp 
in  a  hot  country  will  be  in  better  health  for  a  diet 


—78— 

restricted  especially  in  meats  and  fats.  In  the 
former  case,  a  wise  commander  will  purchase  with 
his  ration  allowance  the  greatest  possible  amount  of 
real  food  utilizing  the  government  straight  ration; 
whereas  in  the  latter  he  will  cut  down  on  the  beef 
and  beans  and  purchase  more  delicate  and  less  heat- 
ing foods.  You  will  find  that  time  devoted  to  the 
conduct  of  your  company  mess  is  well  spent.  A  well- 
fed  body  of  men  is  content,  willing  to  work,  and  dis- 
inclined to  indulge  in  drunkenness.  A  well-fed  com- 
pany becomes  an  organization  which  enlisted  men 
desire  to  join  and  stay  with.  Consequently  it  can 
build  up  a  cadre  of  good  men.  Moreover  if  you  do 
not  watch  your  mess,  you  will  not  only  find  dis- 
content and  disciplinary  troubles,  but  you  will  find 
financial  frauds  and  dishonesty  sooner  or  later 
among  the  men  to  whom  you  leave  the  matter. 
General  Orders  45,  1916,  has  the  following  on  foods 
and  drink  in  camps: 

"Food  and  Drinks. — No  food,  drinks,  or  like 
commodities  will  be  sold  in  camp  except  in  the  au- 
thorized exchanges. 

Attention  is  called  to  the  use  of  the  following 
foods,  the  elimination  of  which  from  the  messes  will 
serve  to  prevent  a  variety  of  intestinal  disorders : 

(a)  Canned  milk  and  fish  opened  the  day  be- 
fore.    (Fish  and  milk  poisoning.) 

(b)  Hashes   of  meats   and   potatoes   prepared 
the  night  previous.     (Ptomaine  poisoning  of  severe 
type.) 

(c)  Locally  grown  green  vegetables,  uncooked. 
(Dysenteries  and  diarrhea.)" 

The  field  cooking  may  be  of  any  character  from 
the  individual  cooking  of  active  campaign  to  the 
comparatively  elaborate  methods  of  permanent 
camps.  At  the  present  time  the  field  range  is  the 


—79— 

most  usual  means  of  field  cooking.  Time  is  lacking 
for  details  concerning  field  paraphernalia  for  cook- 
ing. A  few  simple  rules  will  suffice. 

1.  Kitchens,  messes  and  food-store  tents  must 
be  located  at  opposite  end  of  company  from  latrines. 
(F.S.R.  Par.  246.) 

2.  Kitchens   should  be   sheltered  in  marching 
command  by  tent  fly  and  brush  shelter  when  pos- 
sible ;  in  prolonged  camp  by  a  fly  proof  shack. 

3.  Kitchen  floors  should  be  well  tamped,  and 
sprinkled  before  each  sweeping,  and  should  be  well 
ditched. 

4.  Kitchens  and  all  utensils  must  be  clean  at  all 
times.     Screened  kitchen  shacks  should  have  im- 
provised fly  traps. 

5.  All  fresh  food  should  be  covered  or  protected 
from  flies,  dust  and  dirt  at  all  times.     Fresh  food 
should  be  handled  in  a  cleanly  manner.     This  in- 
cludes bread. 

6.  Garbage  and  other  refuse. should  not  be  col- 
lected in  or  about  a  kitchen.    Much,  if  not  all  of  it, 
can  be  incinerated  at  once. 

7.  Men   should  not  be  permitted   to   sleep   im 
kitchen  or  food-store  tents,  nor  to  eat  in  their  sleep-) 
ing  quarters. 

8.  Ice  boxes  and  drinking  water  barrels  should 
not  be  sunk  in  the  earth. 

9.  Tinned  meats  and  vegetables  should  be  re- 
jected if  perforated  or  bulging  or  otherwise  evi- 
dencing contamination. 

10.  Not  only  the  kitchen,  food-store  tent,  and 
mess  tent  should  always  be  scrupulously  clean  and 
fly  free,  but  the  earth  surface  around  and  about 
these  places. 


11.  Make  it  clear  to  your  mess  sergeants  and 
cooks  that  you  will  not  be  satisfied  with  anything 
less  than  absolute  cleanliness  in  their  department. 

12.  Enforce  your  views  by  frequent  personal  in- 
spection and  disciplinary  measures  for  neglect. 

Disposal  of  Wastes 

Wastes  may  be  classified  as: 

1.  General  refuse. 

2.  Human    excrement. 

3.  Animal  excrement. 

4.  Kitchen  wastes. 

5.  Waste  waters  from  kitchens,  shower  baths,  etc/ 

F.S.R.  provides  for  the  disposal  of  general 
refuse  as  follows :  "The  camp  is  policed  daily  after 
breakfast  and  all  refuse  matter  burned." 

F.S.R.  provides  for  disposal  of  human  dis- 
charges as  follows : 

"Latrines  for  the  men  are  always  located  on  the 
opposite  side  of  the  camp  from  the  kitchens,  gen- 
erally one  for  each  company  unit  and  one  for  the 
officers  of  a  battalion  or  squadron.  They  are  so 
placed  that  the  drainage  or  overflow  can  not  pollute 
the  water  supply  or  camp  grounds. 

When  the  camp  is  for  one  night  only,  straddle 
trenches  suffice.  In  camp  of  longer  duration,  and 
when  it  is  not  possible  to  provide  latrine  boxes,  as 
for  permanent  camps,  deeper  trenches  should  be  dug. 
These  may  be  used  as  straddle  trenches  or  a  seat 
improvised.  When  open  trenches  are  used  the  ex- 
crement must  be  kept  covered  at  all  times  with  a 
layer  of  earth.  In  more  permanent  camps  the 
trenches  are  not  over  2  feet  wide,  6  feet  deep,  and  12 
feet  long,  and  suitably  screened.  Seats  with  lids  are 
provided  and  covered  to  the  ground  to  keep  flies  from 
reaching  the  deposits;  urinal  troughs  discharging 


—81— 

into  the  trenches  are  provided.  Each  day  the  latrine 
boxes  are  thoroughly  cleaned,  outside  by  scrubbing 
and  inside  by  applying  when  necessary  a  coat  of  oil 
or  whitewash.  The  pit  is  burned  out  daily  with 
approximately  one  gallon  of  oil  and  fifteen  pounds 
of  straw.  When  filled  to  within  two  feet  of  the 
surface  such  latrines  are  discarded,  filled  with  earth, 
and  their  position  marked.  All  latrines  and  kitchen 
pits  are  filled  in  before  the  march  is  resumed.  In 
permanent  camps  and  cantonments,  urine  tubs  may 
be  placed  in  the  company  street  at  night  and  emptied 
after  reveille."  This  paragraph  briefly  states  the 
methods  commonly  employed  in  our  service.  G.  0. 
45,  1916,  disposes  of  excreta  as  follows : 

"Disposal  of  Excreta. — Where  a  water  car- 
riage system  is  not  feasible,  the  Havard  box  will  be 
used  over  the  earth  latrines.  Daily  inspection  of  this 
system  is  enjoined  on  the  part  of  the  medical  officer 
of  the  organization,  who  will  see  that  the  following 
plan  is  carried  out : 

(a)  The  latrine  will  be  burned  out  daily  with 
crude  oil  and  hay.     (Each  burning,  one  gallon  crude 
oil  and  fifteen  pounds  of  hay  or  straw.) 

(b)  The  boxes  will  be  at  all  times  kept  fly  tight ; 
this  implies  closure  of  all  cracks,  care  of  the  hinges 
and  a  back  construction  so  that  the  lids  drop  auto- 
matically.    The  latrine   seats  will  be  washed   off 
twice  weekly  with  a  one  one-hundredths  solution  of 
creolin,    or    other    disinfectant,    and    whitewashed 
inside  twice  weekly. 

(c)  When  filled  to  within  two  feet  of  the  top, 
latrines  will  be  filled  with  dirt,  their  position  marked, 
and  new  latrines  constructed. 

(d)  Where  water  carriage  system  is  in  vogue, 
either  the  automatic  flush  or  trough  systefn  will  be 
installed." 


—82— 

In  the  foregoing  order  it  is  customary  to  have 
a  noncommissioned  officer  such  as  the  noncommis- 
sioned officer  in  charge  of  quarters  take  a  squad  and 
carry  out  the  burning  described  under  (a) .  For  the 
compliance  with  requirement  (b)  it  is  an  excellent 
plan  to  require  the  company  artificer  to  visit  the 
company  latrine  daily  and  repair  defects. 

Animal  excreta  is  always  a  difficult  problem 
especially  in  a  large  camp.  Only  the  highest  dis- 
cipline, and  constant  labor  will  dispose  of  the  mass  of 
manure  and  picket  line  refuse.  The  reason  that  its 
destruction  is  so  imperative  lies  in  the  fact  that 
manure  is  the  natural  breeding  place  for  flies.  It  is 
estimated  that  ninety  per  cent,  of  flies  breed  in 
manure  and  horse  droppings.  The  complete  process 
requires  about  ten  days.  The  fly  larvae  burrow  into 
the  depths  of  the  manure  or  the  damp  earth  beneath 
until  maturity  is  reached,  so  that  an  apparently 
harmless  manure  pile  may  harbor  millions  of  flies. 
The  fly  you  must  remember  is  just  as  much  to  be 
regarded  as  a  danger  as  the  enemy's  bullet,  and  may 
kill  off  your  men  in  much  greater  number. 

G.  O.  45  directs  as  follows : 

"Disposal  of  Manure  and  Care  of  Picket  Lines. 
— All  manure  will  be  hauled  to  the  camp  dump. 
Picket  lines  will  be  kept  broom  swept,  and  all  manure 
and  straw  hauled  off  daily.  A  weekly  incineration 
of  the  picket  lines  will  be  accomplished  with  crude 
oil  at  the  rate  of  10  gallons  to  each  line.  Crude  oil 
may  be  obtained  from  the  Quartermaster  Corps  on 
usual  requisition." 

The  foregoing  paragraph  merely  transfers  the 
manure  and  with  it  the  responsibility  for  its  dis- 
position to  another  place,  e.  g.  the  camp  dump.  A 
camp  dump  must  be  at  least  one  mile  from  camp,  and 
in  the  opposite  direction  from  prevailing  winds  when 


—83— 

there  are  such.  At  the  camp  dump,  manure  may  be 
disposed  of  by  burning  in  a  huge  improvised  in- 
cinerator; or  by  spreading  out  in  thin  layers  for 
drying.  The  first  way  requires  much  constant  labor, 
some  fuel  and  the  highest  discipline,  especially  in 
large  commands.  The  second  way  requires  labor, 
discipline  and  constant  official  supervision,  so  much 
so  as  to  also  prohibit  complete  success.  Those  of 
your  number  who  may  have  ever  attempted  to  gov- 
ern fatigue  parties  distributing  manure  in  a  thin 
layer  over  the  earth's  surface  will  readily  visualize 
the  difficulty  of  so  governing  the  same  work  for  a 
division.  One  or  the  other  of  these  ways  may  be  suc- 
cessful with  a  small  body  of  troops.  The  very  best 
way  for  a  large  command  such  as  a  brigade  of 
mounted  troops  or  an  infantry  division  is  by  arrange- 
ment with  some  commercial  parties  to  haul  away  by 
train  or  otherwise  the  entire  supply  each  day.  If 
this  can  not  be  done,  the  best  way  is  to  have  the 
dump  at  least  two  miles  from  any. part  of  the  camp. 
Flies  rarely  travel  so  far  unless  carried  by  high 
winds.  Carcasses  of  dead  animals  should  be  carted 
to  a  spot  selected  by  a  sanitnry  officer  and  there 
burned  or  buried.  The  latter  is  usually  the  more 
practical  plan. 

G.  0.  45  prescribes  the  disposition  of  kitchen 
wastes  as  follows : 

"Disposal  of  Garbage. — For  detachments  or 
companies  in  camps,  or  in  isolated  location  where 
other  means  are  not  available,  the  incinerator  will 
be  installed. 

If  wood  is  plentiful  and  medium-sized  stones 
can  be  obtained,  both  liquid  and  solid  refuse  can  be 
disposed  of  by  using  incinerators  improvised  for  each 
company  as  follows: 


—84— 

A  pit  is  dug  about  five  feet  long,  two  and  one 
half  feet  wide,  and  six  inches  deep  at  one  end  and  12 
inches  at  the  other;  the  excavated  earth  is  banked 
around  the  pit  and  the  latter  is  then  filled  with  stones 
on  which  a  fire  is  built ;  when  the  stones  have  become 
heated,  liquid  refuse  is  poured  into  the  pit  (shallow 
end),  where  it  gradually  evaporates;  solid  matter 
is  burned  on  the  fire. 

The  efficiency  of  this  type  of  incinerator  depends 
largely  upon  the  fact  that  porous  earth  absorbs  a 
very  large  part  of  the  liquid  slops,  but  is  not  con- 
sidered practicable  to  destroy  the  usual  accumula- 
tion of  slops  every  day  without  using  an  extrava- 
gant amount  of  fuel. 

A  type  of  incinerator  having  a  fire  bed  of  rock 
one  foot  deep  will  not  permit  the  heat  from  the  fire 
to  penetrate  beyond  that  depth.  The  rock  wall  on 
three  sides  of  the  fire  bed  absprbs  much  heat  that 
otherwise  might  be  dissipated  into  space,  which  in- 
creases the  evaporating  capacity  of  the  incinerator 
enormously,  and  requires  a  comparatively  very  small 
amount  of  fuel.  Incinerators  built  of  large  rocks  are 
considered  to  be  most  efficient. 

About  one  sixth  of  a  cord  of  wood  per  day  per 
company  is  considered  more  than  sufficient  for  the 
destruction  of  all  slops  and  garbage  if  ordinary  care 
and  attention  are  given  the  incinerator.  Liquid 
slops  should  be  evaporated  by  being  poured  slowly 
along  the  vertical  walls  of  the  incinerator  not  upon 
the  fire  bed,  and  the  solid  garbage  should  be  placed 
on  top  of  the  fuel.  It  has  been  determined  that  a 
skilled  attendant  can  destroy  100  gallons  of  liquids 
and  23  cubic  feet  of  solid  garbage  in  about  12  hours 
by  using  one  sixth  of  a  cord  of  wood. 

Where  rock  is  not  available,  material  (brick 
340,  lime  three  fourths  bag)  will  be  obtained  on 


—85— 

requisition  from  the  quartermaster.  Where  dis- 
posal in  a  sanitary  way  can  be  made  by  means  of 
carts,  the  garbage  can  may  be  used.  The  cans  will 
be  thoroughly  cleaned,  scalded,  and  coated  with 
crude  petroleum  after  emptying. 

Kitchens  and  Mess  Rooms. — Kitchens  and 
mess  rooms  will  be  securely  screened  and  an  efficient 
fly  trap  provided  for  catching  such  flies  as  gain 
entrance  thereto.  An  eflfectiye  fly  trap  consisting  of 
a  light  wooden  frame  covered  with  wire  gauze,  ex- 
tending to  about  one  eighth  of  an  inch  of  the  floor  of 
the  trap,  is  readily  constructed.  It  has  been  found 
that  sweetened  water  slightly  acidulated  with  vine- 
gar is  an  excellent  bait. 

Ice  boxes  installed  will  be  inspected  daily  and 
drip  pans  emptied  and  scalded  out. 

Garbage  cans  will  be  kept  on  wooden  racks  and 
elevated  from  the  ground  and  cans  burned  out  daily 
with  oil  to  prevent  fouling,  and  kept  clean  outside 
with  a  coat  of  whitewash." 

There  are  briefly  three  ways  of  disposing  of 
kitchen  garbage,  burning,  carting  off  and  burying. 
In  a  general  way  their  relative  sanitary  value  is  as 
in  the  order  named.  Sometimes,  two  methods  may 
be  combined,  thus  for  example :  solids  burned,  liquids 
carted  off  or  burned.  The  principle  involved  is  to 
leave  no  organic  refuse  in  or  about  camp,  to  pollute 
water  of  food  supplies  or  harbor  and  breed  flies. 

Waste  waters  from  shower  baths  must  be  car- 
ried off  by  natural  or  improvised  watercourse  so  as 
not  to  be  a  source  of  mosquito  breeding  or  a  nuisance 
to  a  camp. 

Hygiene  of  the  March. — A  few  remarks  must 
suffice.  The  health  as  well  as  the  comfort  of  march- 
ing commands  is  influenced  by  the  manner  in  which 
its  details  are  arranged.  A  commander  should  con- 


—86— 

sider  these  when  military  necessity  does  not  rule 
otherwise.  When  a  prolonged  march  extending  over 
many  days  is  undertaken,  especially  by  a  command 
not  inured  to  marching,  it  is  wise  to  begin  the  jour- 
ney by  short  daily  maches,  gradually  working  the 
men  up  to  longer  marches.  In  this  way,  the  men 
gradually  harden  up,  their  feet  toughen  and  by  the 
end  of  a  week,  they  are  fit  for  the  longer  hikes.  He 
who  gives  very  long  hard  marches  on  the  first  three 
days  will  not  hasten  the  ultimate  time  of  arrival, 
nor  bring  an  equal  number  of  fit  men  to  the  goal. 
This  rule  applies  to  regular  troops  as  well  as  others. 
An  average  day's  march  for  commands  not  greater 
than  a  brigade  is  for  foot  troops  15  miles,  mounted 
troops  20  to  25  miles.  For  divisions  or  larger  bodies 
the  journey  must  be  cut  down  20  per  cent.  Troops 
hardened  or  spurred  by  necessity  may  of  course 
cover  much  more  territory.  Remember  that  a  com- 
mand that  is  soft  may  much  more  readily  march  20 
miles  on  one  day  than  45  miles  in  three  days,  in 
other  words  the  fatigue  is  cumulative  for  unseasoned 
men,  because  they  do  not  recover  from  one  day  of 
fatigue  when  the  next  begins. 

The  time  selected  for  marching  has  appreciable 
effect  upon  physical  condition  of  men  and  animals. 
Night  marches  or  marches  beginning  before  day- 
break depress  the  spirits  of  men  and  the  vitality  of 
men  and  animals.  Especially  is  it  hard  on  animals 
to  march  before  they  have  had  their  food  in  quiet 
and  at  the  customary  time.  In  very  hot  places,  how- 
ever, marches  are  best  conducted  either  in  the  early 
morning  hours  or  late  afternoon  and  evening.  When 
a  day's  march  begun  in  the  early  forenoon  can  not 
be  concluded  by  1:00  P.  M.  it  is  wiser  to  break  its 
fatigue  by  a  halt  and  light  lunch  shortly  before  noon. 
Similarly  all-night  marches  should  be  broken  about 


—87— 

midnight  by  a  light  meal.  Customarily  men  march 
fifty  minutes  and  rest  ten  in  the  hour,  thus  cover- 
ing about  2^  miles  each  hour.  A  faster  rate  is 
more  than  proportionally  wearisome.  It  is  wise  to 
march  methodically  by  the  watch.  The  leading 
troops  march  more  easily  than  the  tail  of  the  column. 
Therefore  in  long  marches,  each  unit  should  have  its 
turn  as  the  leading  element.  At  the  first  halt  on 
the  day's  march,  a  period  of  twenty  minutes  is  usual- 
ly given  men  to  relieve  themselves,  readjust  packs  or 
otherwise  get  in  marching  trim. 

Marching  troops  can  eat  and  digest  most  any- 
thing, so  that  no  especial  sanitary  rules  apply  to 
troops  in  this  status.  A  moderate  morning  meal 
eaten  leisurely  at  least  one  half  an  hour  before  tak- 
ing the  road  is  the  best  provision  for  the  coming 
journey.  The  discipline  of  a  command  is  well  gauged 
by  its  conduct  respecting  water  drinking  on  the 
march.  It  is  an  excellent  rule  for  a  company  com- 
mander to  require  his  men  to  start  the  day's  march 
with  a  canteen  filled  with  water,  and  with  a  clear 
understanding  that  none  shall  have  further  supply 
until  at  least  one  half  hour  after  concluding  the  day's 
march.  The  only  exception  is  the  march  in  exces- 
sively hot  weather  when  a  greater  water  supply  must 
be  provided.  This  should  either  be  transported  with 
the  command  or  taken  from  sources  examined  or  ap- 
proved by  the  C.  O.  Men  should  never  be  allowed 
to  break  ranks  and  forage  for  water  except  in  cir- 
cumstances of  extraordinary  necessity.  This  rule 
should  be  enforced  for  discipline  and  training  as 
well  as  health.  The  cardinal  rules  for  a  snapshot 
judgment  of  water  supplies  have  been  already  re- 
cited. If  you  have  a  medical  officer  along,  put  him 
on  the  trail  of  the  water  supply  as  soon  as  you  near 
the  place  of  noon  or  evening  halt.  If  not,  exercise 


—88— 

your  own  judgment,  remembering  the  instructions 
in  F.  S.  R.  concerning  the  boiling  of  suspicious 
waters,  and  the  protection  of  your  water  supply  by 
guards. 

The  care  of  the  feet  of  your  men  is  extremely 
important.  It  should  have  begun  long  prior  to  a 
march  by  personal  supervision  of  the  shoeing  of 
your  men;  by  personal  bi-monthly  inspection  of 
your  men's  feet ;  by  inspection  of  the  shoes  and  socks 
of  your  men  before  the  march ;  and  by  the  harden- 
ing and  seasoning  of  your  men  by  practice  hikes. 
These  are  all  prescribed  by  War  Department  orders, 
and  if  their  provisions  have  been  intelligently  and 
faithfully  executed,  you  will  have  little  or  no  trouble 
on  the  march.  But  if  you  have  neglected  them, 
your  men  will  suffer,  and  you  may  have  the  morti- 
fication of  seeing  your  company  crippled  by  the  disa- 
bility of  footsore  men.  Higher  commanders  now 
place  the  blame  for  this  condition  on  the  unit  com- 
mander. In  order  to  lessen  the  woes  of  the  footsore, 
require  your  men  to  start  with  good  shoes  and  socks, 
and  if  allowable  with  a  pair  of  gym  shoes  or  slippers 
for  resting  the  feet  after  the  day's  march.  At  the 
termination  of  a  day's  march,  men  should  bathe 
their  feet  when  practicable  in  cool  water,  dry  them, 
and  apply  clean  dry  socks,  immediately  washing  out 
the  pair  worn.  Blisters  are  best  treated  by  zinc 
oxide  plaster  or  dusting  with  the  regulation  foot 
powder.  Prevention  is  much  simpler  and  more  sat- 
isfactory than  cure  of  bruised  and  blistered  feet. 

When  troops  are  marching  in  an  inhabited  coun- 
try or  when  travelling  along  routes  which  will  be 
traced  or  retraced  by  themselves  or  their  comrades, 
it  is  imperative  that  the  road  shall  not  be  left  in  a 
polluted  state.  Therefore  when  a  command  reaches 
the  place  for  the  day's  halt,  the  commander  selects 


—89— 

sites  for  latrines,  and  causes  there  trenches  to  be 
dug  at  once.  In  a  fly  country  a  guard  is  placed  over 
each  straddle  trench  to  compel  men  to  cover  their 
deposit  with  earth.  Before  resuming  the  march,  the 
site  of  the  bivouac  is  properly  policed.  This  con- 
stitutes the  "good  manners"  of  an  army. 


Lecture     IV 


i 


THE  SANITARY  SERVICE  OF  THE 
MARCH   IN   CAMPAIGN 

T  MAY  be  said  that  the  Sanitary  Service  of  the 
March  should  begin  with  the  physical  examina- 
tion of  the  recruit.  Napoleon,  the  most  illustrious 
of  all  eugenists,  is  alleged  to  have  begun  before  this, 
when  he  sent  recruiting  sergeants,  selected  for  their 
mental  and  physical  qualities,  to  the  villages  of 
France,  almost  depopulated  of  fit  adult  males  by  the 
ravages  of  war.  Certainly  the  selection,  training, 
clothing,  and  equipment  of  the  soldier  must  be  con- 
trolled carefully,  in  order  to  permit  efficiency  on  the 
march,  and  in  combat;  and  this  canot  be  too  pains- 
taking and  thorough.  Given  the  recruit  of  proper 
conformation,  as  shown  by  physical  examination,  he 
should  be  trained  physically  and  mentally  for  the  du- 
ties which  will  be  required  of  him.  His  clothing, 
shoes,  and  equipment,  must  be  furnished  and  ad- 
justed in  such  a  manner,  as  to  permit  freedom  of 
movement,  without  constriction  or  interference  with 
organic  functions;  and  he  must  be  instructed,  and 
physically  trained  by  carefully  graduated  exercises 
in  use,  and  manner  of  carriage  of  equipment,  march- 
ing, and  personal  and  general  hygiene.  This  train- 
ing must  not  be  excessive,  as  to  duration  in  time  of 
effort,  at  first,  because  the  average  American  recruit 
has  had  little  training  in  walking  and  weight  carry- 
ing, and  his  physical  development  is  not  completed. 
Excessive  drill  will  not  only  retard  his  set  up,  and 
development,  but  may  possibly,  give  a  temporary 
91 


—92— 

breakdown  in  some  part  of  the  organs  of  locomotion 
(most  frequently  in  the  feet) ,  and  by  reason  of  ex- 
haustion and  discomfort  affect  his  morale  as  a 
marcher. 

The  sanitary  service  on  the  march  in  campaign, 
concerns  itself  with  the  institution  of  proper  san- 
itary measures  for  the  prevention  of  disease,  the 
care  and  evacuation  of  the  sick,  and  the  conduct  and 
administration  of  the  personnel  and  material  for 
these  purposes  on  the  march,  in  camp,  and  combat. 

The  attached  sanitary  troops,  before  beginning 
the  march,  supervise  the  final  sanitation  of  the  aban- 
doned camp,  bivouac,  or  field  and  arrange  for  the 
care  and  transportation  of  the  sick  and  disabled; 
usually  each  battalion  surgeon  with  his  unit  per- 
sonnel, covering  the  command  to  which  he  is  at- 
tached, under  the  supervision  of  the  surgeon,  who 
makes  a  final  survey  of  the  situation.  The  battalion 
sanitary  personnel,  consisting  of  a  medical  officer, 
a  noncommissioned  officer,  and  an  orderly  mounted, 
and  one  or  more  litter  squads  of  two  men  each, 
marches  at  the  rear  of  the  battalion  to  which  at- 
tached. This  position  places  the  sanitary  personnel 
at  a  point  where  on  the  ordinary  march  it  will  be 
able  to  observe  the  general  condition  of  the  personnel 
of  the  command,  and  come  up  in  the  course  of  the 
march,  to  any  fall-outs,  without  the  necessity  of 
special  exertion  on  their  part,  or  upon  the  part  of 
anyone  in  going  forward  to  secure  their  services; 
and  permits  observation  of  signals  from  the  front, 
should  service  be  required  in  this  direction.  This 
position  at  the  rear  of  the  battalion,  leaves  the  per- 
sonnel in  position  to  cover,  without  unnecessary 
movement,  the  battalion,  or  any  part  of  it,  should  it 
deploy. 


—93— 

The  medical  officer  with  the  battalion,  will  not, 
at  all  times  confine  himself  to  a  position  at  the  rear 
of  the  battalion,  but  will,  from  time  to  time,  go  for- 
ward to  inform  himself  as  to  changes  in  march  con- 
ditions; the  condition  of  various  members  tff  the 
command  he  has  under  observation;  in  response  to 
calls  for  services ;  and  to  observe  conditions  of  water 
or  other  supply  on  the  route  of  march ;  and  at  halts 
will  supervise  disposal  of  excrement,  wastes,  etc. 
Before  the  noon  halt,  if  there  be  such  a  halt  intended, 
and  before  approach  to  camp,  he  should  ride  forward 
in  order  to  inform  himself  as  to  water,  drainage, 
terrain,  etc.,  in  order  to  give  such  assistance,  from  a 
standpoint  of  sanitation,  as  may  be  necessary. 

Cases,  sick  or  disabled,  requiring  care  or  treat- 
ment, are  sent  with  a  pass,  showing  the  name,  com- 
pany, and  regiment  or  corps,  of  the  sick  person,  to 
the  medical  officer  in  the  rear.  The  medical  officer 
returns  the  pass  showing  the  disposition  of  the  case. 
The  medical  officer  should  dispose  of  this  case  ac- 
cording to  the  conditions ;  he  may  relieve  him  of  his 
pack,  if  he  be  an  infantryman,  and  require  him  to 
march,  or  he  may  put  him  in  an  ambulance  or  any 
other  transportation,  if  there  be  no  ambulance  at- 
tached to  the  organization;  or  he  may  require  him 
to  march  full  pack,  at  the  rear  of  the  organization, 
under  observation.  Wherever  a  fall-out  is  separated 
from  the  organization,  he  is  given  a  diagnosis  tag, 
showing  the  orders  given  him.  The  arms  and  per- 
sonal equipment  of  a  foot  soldier  accompany  him, 
the  mount,  saddle  equipment,  and  saber  of  a  mounted 
soldier  are  returned  to  the  troop,  usually  by  the  n.  c. 
o.,  who  accompanies  him  (F.  S.  R.  343.) 

Rapidly  moving  mounted  commands  will  usual- 
ly have  no  transportation  other  than  mounts  or  gun 
carriages  for  the  disabled,  in  which  case,  the  squad- 


—94— 

ron  surgeon,  must  act  in  accordance  with  the  pa- 
tient's condition,  and  the  circumstances  of  the 
march.  The  patient  may  be  required  to  follow  the 
command  at  a  walk,  he  may  be  sent  back,  escorted 
or  unescorted  by  a  sanitary  soldier,  with  or  without 
wheeled  transportation,  toward  the  main  body,  or 
the  lines  of  communication  or  he  may  be  left,  with 
or  without  an  attendant,  under  shelter,  to  be  cared 
for  by  friendly  inhabitants  or  to  be  picked  up  by 
sanitary  troops,  furnished  with  proper  transporta- 
tion. 

Whatever  action  is  taken  with  regard  to  the  dis- 
position of  the  disabled  and  their  equipment,  careful 
note  and  report  must  be  made  of  it,  in  order  that  all 
may  be  cared  and  accounted  for,  and  at  the  end  of 
the  march,  collected,  examined,  treated,  and,  if  nec- 
essary, evacuated  to  the  rear. 

Those  sanitary  troops  attached  to  separate  or 
independent  battalions,  will  have  in  addition  to  their 
personal  equipment,  one  pack  mule,  with  aid  station 
equipment,  which  will  accompany  the  battalion  com- 
bat train,  of  which  it  is  a  part.  The  sanitary  troops 
attached  to  a  regiment,  are  usually  divided  for 
march,  camp,  and  combat  duties,  into  the  battalion 
or  squadron,  and  headquarters  sections,  giving  to 
the  regiment  of  infantry,  three  battalion  and  one 
headquarters  section. 

The  headquarters  section  usually  consist  of  the 
senior  medical  officer,  the  senior  n.  c.  o.,  one  orderly, 
all  mounted,  and  from  two  to  four  privates  in  num- 
bers, and  mounted  or  dismounted,  in  accordance  with 
the  allowance  of  men  and  animals  for  sanitary  troops 
of  the  arm  with  which  they  are  serving.  The  senior 
medical  officer — the  surgeon — with  his  mounted 
orderly,  marches  with  the  staff  of  the  regimental 
commander,  unless  there  be  no  other  medical  officer 


—95— 

with  the  regiment,  then  he  marches  in  the  rear.  He 
is  required  to  be  with  the  regimental  commander,  in 
order  that  he  may  be  available  for  consultation  with 
regard  to  sanitary  matters,  and  that  he  may  be  in- 
formed as  to  general  and  special  situations,  as  they 
may  arise,  relating  to  various  conditions  that  might 
affect  sanitation  and  care  of  the  troops,  and  the 
handling  of  the  sanitary  troops;  the  selection  of 
camp  sites,  examination  of  water  and  food  supplies, 
disposal  of  wastes,  and  dispositions  of  the  sanitary 
troops. 

The  senior  noncommissioned  officer  of  the  san- 
itary troops  (headquarters  section)  with  the  privates 
of  the  Medical  Department  attached  to  his  section, 
marches  at  the  rear  of  the  last  battalion,  with  the 
sanitary  troops  of  that  battalion,  and  has  in  his 
charge  the  pack  mule,  carrying  the  regimental  aid 
station  equipment,  and  the  ambulance,  if  the  regi- 
ment is  part  of  a  reinforced  brigade  or  division  of 
which  ambulance  companies  are  a  component.  If 
the  regiment  is  acting  independently,  he  will  be  in 
charge  of  the  three  or  four  ambulances  and,  on 
arrival  at  camps,  the  wheeled  transportation,  which 
carries  the  regimental  infirmary  or  hospital.  The 
position  of  the  headquarters  section  of  the  regi- 
mental sanitary  personnel  at  this  point  on  the  or- 
dinary march,  permits  control  of  equipment  and 
transportation  on  the  march,  and  in  case  of  deploy- 
ment, leaves  this  equipment  in  proper  position,  in 
readiness  to  advance  and  establish  where  directed. 
Under  this  condition,  the  wagons  of  the  regimental 
infirmary  or  hospital  would  be  back  in  the  regi- 
mental field  train. 

On  a  march  in  retreat,  in  a  brigade  or  division, 
if  the  regiment  is  not  acting  as  advance  or  rear 


—96— 

guard,  the  distribution  of  sanitary  troops  is  the 
same  as  given  for  the  ordinary  march. 

If  the  regiment  is  marching  alone  with  an  ad- 
vance guard  of  one  battalion,  the  distribution  is  that 
of  an  ordinary  march  and  the  battalion  sanitary 
troops  will  march  with  the  reserves  of  the  battalion, 
with  possibly  one  man  with  support,  if  such  there  is. 
The  formation  will  practically  be  the  same  for  a  regi- 
ment acting  as  advance  guard  with  a  battalion  as  the 
support — each  battalion  will  carry  its  personnel  as 
usual — the  surgeon  will  be  with  the  commanding 
officer,  and  the  battalion  forming  the  support  will 
have  one  or  two  men  of  the  sanitary  personnel,  with 
the  advance  party. 

In  a  retreat  of  a  regiment,  or  a  regiment  acting 
as  a  rear  guard,  the  reserve  will  be  reinforced  by 
the  sanitary  personnel  from  the  main  body  of  the 
battalion  or  regiment,  in  order  that  the  wounded  of 
the  retreating  rear  guard  may  be  rapidly  evacuated 
ahead  of  the  troops.  If  ambulances  are  available, 
as  in  a  regiment  acting  independently,  it  may  be  well 
to  attach  one  to  the  tail  of  the  main  body,  between 
it  and  the  reserve  of  the  rear  guard,  leaving  the 
pack  mule  and  remaining  ambulances  to  march  with 
the  leading  battalion. 

Ambulance  companies  are  divisional  sanitary 
organizations,  but  for  purposes  of  care  and  trans- 
portation of  the  sick  and  wounded,  may  be  attached 
to  separate  brigades,  which  are  operating  away  from 
the  division.  Under  the  conditions  of  the  ordinary 
march,  when  hostile  contact  is  not  expected,  ambu- 
lance companies  march  and  camp  together,  with 
the  exception  of  one  ambulance  company,  which 
under  proper  orders  may  have  its  ambulances  dis- 
tributed through  the  column,  one  to  each  regiment, 
for  use  in  transportation  of  the  disabilities  that 


—97— 

occur  on  the  march.  (F.  S.  R.  341.)  Under  these 
conditions  of  the  ordinary  march,  those  ambulance 
companies,  not  concerned  in  the  regimental  service 
for  the  day,  march  as  do  other  organizations ;  their 
positions  ordinarily  in  the  rear  of  the  field  trains 
when  marching  as  a  unit,  with  their  field  wagons; 
when  marching  with  light  transportation  (pack 
mules)  only  the  ambulance  companies  march  in  ad- 
vance of  the  field  trains. 

Under  conditions  of  untrained,  or  fatigued  per- 
sonnel, bad  weather,  or  long  marches,  action  may  be 
taken  to  increase  the  number  of  ambulances  tem- 
porarily attached  to  the  regiment,  for  the  purposes 
of  the  march,  as  much  as  may  be  necessary.  These 
ambulances  so  distributed  to  the  regiments  are  for 
use  in  transportation  of  the  disabled  and  their  equip- 
ment, and  must  not  be  diverted  to  any  other  use. 
They  are  under  the  orders  of  the  Director  of  Ambu- 
lance Companies  and  their  movement  will  be  con- 
trolled by  him,  in  carrying  out  the  orders  of  the 
surgeon  or  the  commanding  officer.  At  the  begin- 
ning of  an  engagement,  or  at  the  end  of  the  march 
the  distributed  ambulances  will  be  assembled  by  the 
orders  of  the  director,  usually  given  through  the 
company  commander.  All  disabled  sick  in  the  ambu- 
lances at  this  time,  who  require  more  than  temporary 
care  or  transportation  will  usually  be  sent  back  by 
the  regimental  surgeon  with  the  ambulances.  When 
they  move  to  assemble  in  preparation  for  an  engage- 
ment, the  disabled  will  be  collected  at  some  central 
point  in  the  rear  for  further  evacuation,  if  on  arrival 
at  camp,  at  the  probable  site  of  the  camp  infirmary, 
or  to  the  field  hospital  for  further  treatment  and 
evacuation  according  to  the  conditions  and  orders. 

This  arrangement  of  the  ambulance  companies 
in  column  for  the  ordinary  march,  is  to  permit  such 


—98— 

use  of  organizations  as  may  be  necessary '  for  the 
transportation  of  the  disabled,  and  to  permit  rapid 
collection  of  the  disabled  on  arrival  at  camp,  without 
unnecessary  movement  of  disabled  or  transportation. 

The  ambulance  companies  whose  ambulances 
are  not  distributed  to  the  organizations  on  the 
march,  are  held  in  their  position  behind  the  field 
trains,  as  they  camp  at  the  rear  of  the  center  of  the 
division,  and  ordinarily  not  more  than  one  is  con- 
cerned in  regimental  duty.  With  this  position,  they 
do  not  become  involved  in  the  movement  of  the  field 
trains  to  their  organizations  or  on  their  return ;  and 
are  in  position  to  join  the  column  for  the  next  day's 
mrach.  The  details  for  march  duty  with  the  regi- 
ments, will  be  made  by  the  director,  ordinarily  by 
roster,  and  the  positions  in  column  will  be  determ- 
ined in  a  like  manner  by  the  Director  of  Ambu- 
lance Companies,  acting  as  a  battalion  commander. 

Changes  from  the  routine  order  of  march,  will 
usually  be  made  on  recommendation  of  the  surgeon, 
in  the  march  order,  according  to  the  necessities  of 
the  case.  This  position  of  the  ambulance  companies 
behind  the  field  trains,  places  them  sufficiently  far 
forward  to  permit,  in  case  of  rencontre,  advance  of 
the  ambulance  companies  sufficiently  early  to  be  of 
use  when  required,  and  yet  not  have  them  as  far  for- 
ward as  to  have  them  unnecessarily  involved  in 
conflict. 

The  ambulance  companies  with  light  transpor- 
tation, march  at  the  tail  of  the  combatant  column; 
such  a  position  usually  is  the  result  of  a  desire  to 
have  the  more  mobile  part  of  the  organizations 
ready  for  early  use,  or  is  the  result  of  difficult  roads, 
or  failure  of  heavy  wheeled  transport :  either  condi- 
tion, if  the  ambulance  companies  were  kept  behind 
the  heavy  transportation  of  the  field  trains,  might 


—99— 

possibly  put  them  so  far  back  as  to  render  them 
useless. 

The  usual  order  of  march  of  an  ambulance  com-6 
pany  is  that  of  ordinary  commands  of  mixed  organi- 
zations. The  foot  troops,  the  bearer  sections  with 
litters,  first,  followed  by  the  pack  mules  with  the 
dressing  station  detachment,  next  the  ambulance 
detachment,  and  lastly,  the  three  wagons:  The 
first  wagon  carries  reserve  dressings  and  equipment 
for  the  dressing  station,  and,  where  possible,  accom- 
panies the  dressing  station  party  forward  as  a  com- 
bat wagon. 

The  road  distance  of  an  ambulance  company  on 
the  march  without  elongation  is  125  yards  motor, — 
200  yards  mule.  The  Director  of  Ambulance  Com- 
panies ordinarily  accompanies  the  ambulance  com- 
pany in  advance  on  the  march,  such  a  position  places 
him  so  that  he  will  be  able  to  receive  messages  from 
the  front  and  rear,  easily,  and  yet  supervise  the 
work  of  his  organizations  as  it  occurs.  This  ad- 
vanced position  also  gives  him  an  opportunity  to 
familiarize  himself  with  the  conditions  of  roads,  ter- 
rain, etc.  On  ordinary  marches,  particularly  when 
the  roads  are  dusty,  the  dismounted  detachments  of 
the  sanitary  battalion  are  frequently  marched  to- 
gether, as  a  matter  of  comfort,  followed  by  the  pack, 
ambulance  and  wagon  detachments,  combined  in  ord- 
er of  the  companies ;  such  action  while  removing  the 
transportation  from  immediate  control  of  the  com- 
manding officer,  does  not  cause  material  delay  in 
going  into  action ;  as  these  detachments  have  medi- 
cal officers  in  command,  and  objection  on  this  score 
does  not  hold  good — the  conditions  of  the  march 
are  certainly  improved  greatly. 

The  march  in  the  presence  of  the  enemy,  where 
hostile  contact  may  be  expected,  requires  as  it  does 


—100— 

with  the  line  troops,  a  different  arrangement  of  the 
ambulance  companies  in  the  column.  With  the  rein- 
forced brigade,  the  single  ambulance  company  at- 
tached is  moved  up  in  advance  of  the  field  trains,  to 
the  tail  of  the  column  of  combatant  troops ;  so  that  it 
will  not  be  forced  to  participate  in  the  retirement  of 
the  field  trains,  if  such  retirement  is  necessary,  and 
that  it  may  be  in  readiness  for  action,  should  the 
bridgade  deploy  for  attack  or  defense,  and  in  case  of 
retreat,  be  sufficiently  advanced  to  permit  detach- 
ment of  a  platoon  of  ambulances  and  bearers  for 
duty  with  the  rear  guard,  for  the  purpose  of  expedit- 
ing the  evacuation  of  the  wounded. 

The  distance  from  the  reserve  of  the  rear  guard 
to  the  tail  of  the  main  body  of  the  brigade,  will  be 
about  4,000  yards,  a  distance  that  could  be  traversed 
by  the  ambulance  company,  if  necessary,  while  the 
brigade  is  deploying,  if  it  were  desirable  to  bring  it 
up  to  this  point.  Such  action  however  would  not  be 
contemplated  until  late  in  the  action,  and  if  the 
dressing  station  establishes,  it  will  be  well  to  the 
rear.  The  regimental  sanitary  personnel  will  be 
sufficient  to  care  for  the  wounded  until  the  dressing 
station  can  go  into  action  and  the  position  of  the 
ambulance  company  at  the  rear  of  the  column  is 
correct,  for  a  column  of  this  size. 

With  a  brigade  in  retreat,  however,  if  the  am- 
bulance company  were  marched  with  the  leading 
troops  (with  the  same  4,000  yards  from  the  reserve 
of  the  rear  guard)  in  default  of  wheeled  transporta- 
tion, the  wounded  resulting  from  a  general  rear 
guard  action  must  be  abandoned  or  carried  by  hand. 

If,  as  mentioned  above,  a  platoon  of  3  ambu- 
lances be  attached  to  the  reserve  of  the  rear  guard, 
with  5  or  6  litter  squads  from  the  bearer  detachment, 
these  reinforced  by  the  regimental  sanitary  person- 


nel  will  be  able,  under  ordinary  conditions,  to  evacu- 
ate a  considerable  portion  of  the  wounded  requiring 
transportation. 

With  a  division  marching  in  the  presence  of  the 
enemy  or  when  hostile  contact  may  be  expected, 
ambulances  will  not  be  distributed  to  the  regiments, 
but  will  be  held  with  the  ambulance  companies, 
With  the  normal  advance  guard  of  one  brigade,  one 
ambulance  company  will  be  attached  to  the  advance 
guard  and  march  usually  at  the  rear  of  the  reserve 
as  the  distance  from  the  tail  of  the  reserve  to  the 
tail  of  the  combatant  troops  of  the  main  body  will, 
without  elongation,  be  some  seven  miles ;  a  distance 
too  great  to  permit  a  unit  of  the  size  of  a  brigade 
to  be  without  medical  assisitance,  other  than  the  re- 
gimental personnel,  during  the  time  it  would  take 
an  ambulance  company  to  come  to  the  front.  If 
a  general  action  is  imminent,  the  advance  guard  will 
be  engaged  for  a  considerable  time  and  the  ambu- 
lance company,  equipment,  and  personnel,  will  be 
required  early.  If  the  advance  must  continue,  this 
equipment  will  be  required  to  take  over  the  wounded 
and  release  the  regimental  personnel,  so,  that  it  can 
continue  with  its  command.  If  a  retreat  is  required, 
this  organization  well  up  to  the  scene  of  action, 
offers  the  only  means  of  evacuation  of  the  wounded. 

The  positions  of  the  sanitary  units  of  a  division 
in  retreat  are  identical  with  those  of  a  march  for- 
mation with  advance  guard,  except,  that  organiza- 
tions are  faced  about,  and,  if  necessity  arises  for 
delaying  actions  of  some  duration,  the  ambulance 
companies  with  the  brigade  rear  guard  may  be 
reinforced  by  additional  ambulance  and  bearer  pla- 
toons, in  order  to  expedite  the  evacuation  of  the 
wounded  of  this  force,  which  must  retreat  soon. 


.-,102— 

Flank  guards  of  a  brigade  or  more,  when  de- 
tached a  sufficient  distance  from  the  main  body  to 
warrant  such  action,  should  be  furnished  a  propor- 
tional amount  of  sanitary  assistance.  As  such  a 
command  must  keep  in  movement  consonant  with 
the  movement  of  the  main  body,  it  must  not  be  im- 
peded by  the  disabled,  and  the  allowance  of  ambu- 
lance company  personnel  and  equipment  should  be 
liberal.  The  method  of  distribution  of  sanitary 
personnel  of  a  flank  guard  on  the  march  is  that  of 
a  brigade  or  division  when  hostile  contact  is  ex- 
pected. 

The  distribution  of  the  three  ambulance  com- 
panies on  the  march  with  a  cavalry  division  con- 
forms to  that  of  an  infantry  division,  except  that 
on  account  of  the  superior  mobility  of  the  cavalry 
division  on  marches  where  contact  may  be  expected, 
it  may  be  frequently  necessary  to  carry  the  packs 
of  the  dressing  station  equipment  and  bearer  de- 
tachment in  ambulances,  leading  the  unloaded  pack 
mules  from  the  tails  of  the  ambulances  in  order  to 
keep  up  with  the  command;  the  wagon  transporta- 
tion being  directed  to  follow  at  best  speed  consistent 
with  constant  marching.  Such  an  arrangement  per- 
mits these  organizations  to  go  forward  with  all  the 
speed  that  can  be  expected  from  mule  drawn  wheel 
transport.  When  getting  into  ground  unsuitable 
for  wheeled  transportation,  the  pack  mules  can  be 
reloaded  and  the  bearer  detachment  move  out  on 
foot  from  the  ambulance  head  with  light  transporta- 
tion. 

The  position  of  the  field  hospitals  of  an  infantry 
division  on  an  ordinary  march  is  at  the  rear  of  the 
ambulance  companies,  which  are  preceded  by  the 
field  trains — the  director  of  the  field  hospitals  usually 
marches  with  the  most  advanced  organization  .  The 


—103— 

duties  of  the  field  hospitals  on  the  ordinary  march 
are  limited  to  arranging  for  establishment  of  suffi- 
cient equipment  to  shelter  the  daily  increment  of 
disabled,  prior  to  evacuation.  As  these  organiza- 
tions camp,  usually  with  the  ambulance  companies, 
in  a  position  to  cover  the  rear  of  the  center  of  the 
divisional  camp,  their  place  in  the  column  conincides 
with  this  intent  and  permits  entrance  into  the 
column  the  following  day  without  confusion. 

The  necessity  of  use  of  field  hospitals  in  action, 
such  as  would  occur  only  under  the  conditions  of  a 
meeting  engagement,  does  not  require,  and  in  fact 
forbids  early  establishment ;  and  the  position  of  the 
field  hospitals  in  this  column,  some  8  miles  from  the 
head  of  the  main  body,  keeps  them  well  out  of  range 
of  light  artillery  fire  and  yet  permits  arrival  in 
proper  position  within  two  hours  if  necessary. 
While  ^the  field  service  regulations  require  a  field 
hospital  to  be  located,  so  as  to  permit  early  care  of 
the  sick  on  arrival  at  camp,  the  camp  infirmary, 
marching  at  the  rear  of  the  brigade,  now  provides 
for  and  can  do  this,  until  the  establishment  of  the 
field  hospital.  Under  conditions  where  delays  of 
trains  may  occur,  a  field  hospital  may  be  marched 
at  the  tail  of  the  main  body,  in  order  to  place  it  in 
position  to  establish  an  hour  and  a  quarter  earlier. 
As  the  road  space  of  a  field  hospital  company  is  only 
90-100  yards,  such  an  arrangement  will  have  little 
effect  in  displacing  the  field  trains  to  the  rear. 

Field  hospitals  with  organizations  marching 
when  hostile  contact  is  expected,  march  with  the 
ambulance  companies  in  advance  of  the  field  trains, 
some  6A  miles  from  the  head  of  the  main  body  in 
position  to  halt  in  readiness  to  establish  or  march 
forward  according  to  the  necessities;  should  the 
division  deploy,  this  position  in  the  column  puts 


—104— 

them  well  up  to  the  front  and  clears  them  f.rom  be- 
ing involved  in  the  field  trains  should  action  occur. 
This  is  essential  as  the  transportation  of  these  or- 
ganizations, field  wagons,  is  heavily  loaded  and  can- 
not move  with  rapidity.  Position  of  these  organiza- 
tions further  forward  with  the  column  would  expose 
them  to  involvement  in  the  movements  of  the  com- 
batant troops  and  possibly  to  artillery  fire  with  no 
advantage,  as  these  organizations  will  not  ordinarily 
be  needed  until  the  action  has  well  developed,  and 
in  their  present  position  have  ample  time  to  establish 
whenever  ordered. 

Field  hospitals  attached  to  brigades  acting  in- 
dependently, conform  to  the  same  conditions  as  in 
the  march  with  larger  units.  Advance,  rear,  and 
flank  guards  of  less  than  a  division,  do  not  ordinarily 
have  field  hospitals  attached  to  them,  but  depend 
upon  the  field  hospitals  attached  to  the  main  body. 

In  the  retreat,  the  positions  of  the  field  hospi- 
tals are  the  same  as  in  the  column  on  a  march  to 
the  front,  the  advance  when  hostile  contact  is  ex- 
pected, except  that  the  organizations  are  faced 
about.  Owing  to  the  slow  movement  of  these  or- 
ganizations, the  transportation  and  material  could 
not  be  used  nearer  the  enemy,  but  the  personnel  will 
be  available  to  assist  the  ambulance  companies  with 
litter  bearers,  in  evacuating  from  the  front,  and  for 
care  of  excess  wounded  sent  back  to  the  sanitary, 
field,  ammunition,  and  supply  wagons,  for  transpor- 
tation. 

All  movements  of  the  divisional  sanitary  units 
other  than  those  routine  to  the  march,  are  directly 
controlled  by  orders  from  headquarters  of  the  com- 
mand, usually  upon  the  recommendation  of  the  sur- 
geon of  the  command.  Detachments  for  ambulance 
duty  with  regiments,  advance,  rear,  and  flank  guards, 


—105— 

are  made  by  roster,  where  possible ;  where  organiza- 
tions are  on  continued  duty  as  flank  guards,  etc.,  it 
is  advisable  not  to  make  frequent  change  of  sanitary 
units,  on  account  of  the  unnecessary  movement  in- 
volved. The  orders  with  regard  to  the  sanitary 
troops  may  come  from  the  combatant  commander, 
or  from  the  surgeon,  when  such  authority  is  dele- 
gated to  him. 

The  relations  of  the  lines  of  communications, 
sanitary  service,  to  the  march  in  campaign  consists 
in  the  renewal  of  the  technical  supplies  of  the  service, 
by  timely  issues,  renewal  of  personnel,  and  the  eva- 
cuation and  care  of  the  disabled.  With  the  ordinary 
march  these  duties  lie  largely  under  the  control  of 
the  surgeon,  advance  group,  of  the  line  of  com- 
munications, whose  duties  are  practically  those  of  an 
advance  field  and  forwarding  agent  for  the  surgeon 
of  the  base  group.  With  the  line  of  communications 
short,  and  near  the  base,  and  efficient  transport 
lines  by  rail,  water,  or  motor,  betwen  the  base  and 
the  transportation  head,  there  will  be  little  inter- 
vening in  the  way  of  sanitary  establishments  or 
equipment;  but  as  the  line  extends,  establishments 
and  units  must  be  brought  up  and  placed  in  accord- 
ance with  conditions  and  requirements.  Under  the 
conditions  of  the  long  line  of  communications,  inter- 
mediate medical  groups  may  be  required. 

The  duty  of  supply  for  the  sanitary  units,  which 
start  the  campaign  with  sufficient  medical  supplies 
for  one  month,  will  be  handled  by  timely  issue  from 
the  advance  medical  depot,  usually  at  a  rail,  water, 
or  motor  head.  These  supplies  for  issue  must  be 
sent  forward  to  the  distributing  point  by  lines  of 
communications  transportation  (as  the  abolition  of 
the  Medical  Reserve  Supply  Company  by  recent 
action,  furnishes  no  supply  wagons  for  this  purpose) , 


—106— 

and  will  there  be  taken  over  by  field  wagons  of  the 
ambulance  company  and  field  hospital  companies, 
which  will  issue  to  the  organizations,  as  required. 
Requisitions  for  supplies  required,  will  come  from 
the  chief  surgeon  of  the  units  requiring  these  sup- 
plies and  probably  they  will  be  issued  under  his 
direction.  This  matter  of  issue  under  the  new  con- 
ditions has  not  been  worked  out  as  yet,  but  the 
method  given,  follows  the  former  method.  Issues 
to  regimental  sanitary  service  can  be  made  by  using 
the  regimental  pack  mule  as  transport,  or  by  the 
camp  infirmary  wagon  attached  to  each  brigade. 
The  technical  supplies  required  consist  of  medicines, 
dressings,  and  hospital  stores,  such  as  arrow-root, 
chocolate,  extract  of  beef,  spices,  soap,  candles, 
evaporated  milk,  tinned  soups,  etc.,  all  packed  in 
convenient  standardized  containers;  the  medicines 
and  foods  in  tin,  whenever  their  chemical  properties 
permit.  Shipments  of  supplies  of  this  character, 
on  account  of  the  urgent  need  for  them,  usually  will 
be  accompanied  to  the  distributing  point  by  a  non- 
commissioned officer  of  the  sanitary  service  of  the 
advance  group,  in  order  to  insure  rapidity  and  cer- 
tainty of  delivery. 

The  service  of  the  evacuation  of  the  disabled 
sick  of  the  march  in  the  campaign,  will  be  organized 
on  the  same  basis  as  that  for  those  resulting  from 
combat.  The  daily  increment  of  sick  for  trained 
troops  in  campaign  as  given  by  Straub,  will  average 
about  one  per  cent,  divided  in  to  the  following 
classes  : 

f  (a)  Able  to  do  duty  (light)  0.3% 
1.  Sick  in  Quarters  ] 

[  (b)  Unable  to  do  any  duty  0.3% 


f  (c)   Slight  _________  P  _____ 

2.  Sick  in  Hospital^ 

[  (d)   Severe   ______________  0.15% 


—107— 


II 


fl    C  m'£  <^"~l 

•ii  fa        -§  a 

s  ?l  2-~  •§ 

Vi   C3  <DT3  >»  g 

~  3   S  >«i-1  *   § 

O  Q£  <J  o  Q  c 

a,  3  days  3  4 

b,  3 —  5  days  4  6 

c,  5—14  days  10  15 

d,  14—50  days  32  51 

But  with  relatively  untrained  troops  or  difficult 
conditions  of  march,  weather,  improper  foot,  etc., 
these  averages  may  be  much  increased — even  from 
5  to  15%. 

The  cases  covered  by  classes  a  and  b,  amounting 
to  6  per  M,  will  under  ordinary  conditions  of  march 
recover  within  three  or  four  days;  a  considerable 
number  of  these  may  be  able  to  march  without  equip- 
ment or  ride  on  the  field  wagons  and  be  available 
as  guards,  etc.  It  would  be  uneconomical  to  send 
these  to  the  rear  and  ordinarily  they  can  be  cared  for 
in  the  regiment  or  at  the  camp  infirmary  and  shel- 
tered with  their  own  equipment.  Classes  c  and  d, 
will  average  from  ten  to  thirty  days  lost  by  sickness 
and  will  require  hospital  treatment.  Such  cases 
cannot  accompany  the  command  and  must  be  evacu- 
ated. Sick  call  will  be  held  by  the  attached  sanitary 
personnel  and  the  light  cases  separated  from  those 
requiring  evacaution  to  the  rear.  The  light  cases 
will  be  treated  by  the  regimental  sanitary  personnel 
or  if  their  equipment  is  sufficient,  at  the  camp  in- 
firmary ;  a  classified  sick  report  will  be  made  to  the 
division  surgeon  and  the  evacuation  cases  taken  to 
the  camp  infirmary,  in  order  that  they  may  be  col- 
lected by  the  ambulance  detachments  assigned  to  this 


^  —108— 

duty.  From,  the  brigade  collecting  point  the  evacu- 
ation cases  are  taken  to  the  field  hospitals,  designated 
to  receive  these  cases,  pending  evacuation  or  if  the 
lines  of  communication,  sanitary  transport  head, 
such  as  a  transport  column,  or  hospital  ship,  or  train, 
is  sufficiently  near  to  require  no  extended  movement 
by  the  ambulance  company,  which  in  all  probability 
has  made  considerable  march,  the  disabled  may  be 
delivered  directly  to  the  lines  of  communication; 
such  conditions  are  unusual,  and  the  chief  surgeon 
will  ordinarily  require  delivery  to  the  field  hospitals. 

The  Director  of  Field  Hospitals,  like  the  Direc- 
tor of  Ambulance  Companies,  will  receive  informa- 
tion from  the  division  surgeon,  as  to  the  number  of 
evacuation  cases,  and  each  of  these  officers  will  have 
designated  the  units  to  take  care  of  the  transporta- 
tion and  shelter  these  cases,  and  they  will  be  held 
at  the  field  hospitals  pending  arrival  of  the  lines  of 
communication,  transport  column.  These  cases  for 
a  division  will  amount  to  about  75  men,  of  which  a 
considerable  number  will  be  recument.  The  total 
sitting  for  an  ambulance  company  of  12  ambulances 
is  at  most  108 ;  the  total  recumbents  48.  Ordinarily, 
one  ambulance  company  will  be  sufficient  to  collect 
them,  and  for  purposes  of  economy  in  travel,  that 
company  assigned  for  duty  with  regiments  on  the 
march,  will  usually  be  designated  as  a  routine  for 
this  duty,  by  the  Director  of  Ambulance  Companies, 
as  it  has  marched  in  with  the  regiments  and  is  al- 
ready loaded  with  some  of  the  cases  and  will  collect 
the  remainder  while  at  the  regimental  camp,  or  at 
the  infirmary. 

The  capacity  of  the  field  hospital  is  216  beds',  it 
will  set  up  such  bedding  units,  as  required  for  the 
disabled,  using  available  shelter,  when  possible,  in 
place  of  tentage. 


—109— 

The  division  surgeon  will  notify  the  lines  of 
communications  of  the  number,  and  classification  of 
cases,  as  soon  as  they  are  reported,  and  give  the 
point  at  which  they  are  collected.  Owing  to  the 
fact  that  lines  of  march  may  be  changed,  and  means 
of  transportation  fail,  the  advance  surgeon  will  have 
his  transport  column  of  mule  ambulances  or  motors 
well  up  to  the  tail  of  the  column,  in  the  zone  of  ad- 
vance at  all  times,  in  order  that  field  hospitals  may 
be  evacuated  as  speedily  as  possible.  Evacuation 
of  the  disabled  will  be  effected  as  rapidly  as  possible 
to  rail  or  water  transportation  heads,  if  practicable, 
distance,  weather,  and  road  conditions,  considered. 
If  evacuation  can  be  made  by  rail  or  water,  as  when 
the  line  of  march  follows  or  intersects  such  routes 
of  transportation,  hospital  trains  or  boats,  will  be 
arranged  for  to  arrive  at  a  place  and  time  agreed 
upon  by  the  division  surgeon  and  the  advance  sur- 
geon. If  evacuation  must  be  by  road,  such  a  route 
should  be  selected  as  will  be  different  where  possible, 
from  that  traversed  by  the  ammunition  and  general 
supply  trains,  in  order  to  prevent  interruption  and 
congestion  of  traffic.  Rest  stations  must  be  estab- 
lished, if  the  number  of  wounded  and  distance  of 
march  warrant  them.  Evacuation  by  rail  or  water 
will  require  receiving  detachments  at  the  transporta- 
tion head,  with  minor  fixed  hospitals  at  the  refilling 
point,  or  back  further  on  the  line  for  arrest  of  the 
cases  of  lesser  gravity;  with  rest  and  feeding  sta- 
tions for  improvised  ambulance  trains. 

During  the  march  in  campaign,  the  evacuation 
hospitals  attached  to  the  line  of  communications,  will 
be  kept  well  up  to  the  head  of  the  line,  so  that  they 
may  be  available  for  rapid  movement  to  the  front. 
These  units  are  without  specially  assigned  transpor- 


—no- 
tation and  must  use  water  or  rail  transportation 
where  possible. 

Wagon  or  motor  transport  from  the  rail  or 
water  head,  must  come  from  the  lines  of  communica- 
tion for  the  final  movement  to  the  relief  of  the  evac- 
uation hospitals.  Under  conditions  of  necessity, 
these  organizations  may  be  used  as  receiving  hos- 
pitals on  the  lines  of  communications,  but  their 
mobility  must  be  impaired  as  little  as  possible,  and 
when  filled,  substitute  organizations  must  be  sent 
up  from  the  rear. 

Convalescent  camps,  and  sanitary  detachments, 
may  be  established  in  the  advance  medical  section 
of  the  lines  of  communications  under  special  condi- 
tions, but  ordinarily  these  will  be  back  in  the  inter- 
mediate or  base  groups. 

The  service  of  supply  of  sanitary  personnel 
begins  within  the  home  territory.  Drafts  of  sanitary 
troops  are  forwarded  to  the  base  of  the  lines  of  com- 
munications, and  held  in  casual  camps,  under  the 
control  of  the  surgeon,  L  of  C,  and  under  the  au- 
thority of  the  commanding  officer,  L  of  C,  assigned 
to  duty  on  the  L  of  C,  for  organization  of  new  units, 
such  as  fixed  hospitals,  rest  stations,  convalescent 
camps,  etc.,  or  to  the  organization  in  the  zone  of  the 
advance.  The  relations  between  the  sanitary  service 
of  the  zone  of  advance,  with  the  L  of  C,  must  be 
carefully  accorded,  or  much  difficulty  will  result. 
Constant  communication  must  exist  between  these 
sections,  and  between  the  sections  of  the  L  of  C, 
themselves ;  and  the  various  officers  of  these  sections 
should  be  given  wide  latitude,  as  to  arrangement  of 
the  duties  of  their  service. 

The  essential  features  of  the  sanitary  service  in 
campaign  are  prevention  of  disease,  and  care,  and 
prompt  graded  evacuation  of  the  disabled,  in  such 


— Ill— 

a  manner  as  to  keep  the  units  organized,  supplied, 
and  unencumbered;  so  that  they  will  be  available 
for  use  under  stress  of  a  large  increment  from  epi- 
demic or  combat — and,  yet,  move  no  case  further  to 
the  rear  than  his  condition  requires. 


Lecture     V 


SANITARY  SERVICE  OF  THE  CAMP 

THE  sanitary  service  of  the  camp  should  begin 
with  an  examination  of  the  campsite,  as  to  po- 
sition, drainage,  soil,  vegetation,  shade,  evidence  of 
recent  occupation,  medical  history  of  the  tract  and 
vicinity,  and  presence  of  objectionable  insects;  the 
investigation  of  the  source,  purity,  and  quantity  of 
water  supply,  -and  means  of  distribution — food  sup- 
ply, as  to  quantity  and  quality,  purity  and  method  of 
handling,  and  quantity  and  quality  of  wood  and 
straw,  and  location  and  availability ;  and  the  location 
of  buildings,  roads,  and  means  of  transportation, 
that  might  be  available  in  the  care  or  evacuation  of 
the  disabled.  Such  an  investigation  should  be  made 
for  every  camp  or  bivouac  by  a  medical  officer,  sent 
ahead  with  the  quartermaster,  who  will  perform 
similar  duties  in  conjunction  with  the  medical  officer. 
Military  necessity  under  stress  of  campaign  or 
combat,  may  require  that  the  various  considerations 
inquired  into,  be  ignored  in  part  or  altogether — for 
very  temporary  camps  or  bivouacs,  for  large  or 
small  commands,  but  early  search  for  proper  sites, 
fulfilling  the  conditions  to  be  discussed  later,  will 
result  in  such  material  advantage  to  the  command,  in 
the  case  of  supply,  early  establishment  without  con- 
fusion, comfort  and  preservation  of  good  feeling  and 
health,  that  such  action  should  never  be  omitted 
either  for  march  bivouacs  and  camps,  or  semi-per- 
manent camps. 

113 


—114— 

The  position  or  situation  of  the  camp  with  re- 
lation to  towns,  villages,  rail  or  water  transporta- 
tion lines,  and  roads,  must  be  considered  from  the 
standpoint  of  supply,  shelter,  and  means  of  transpor- 
tation for  the  command  and  the  sanitary  service, 
as  well  as  with  regard  to  transmission  of  communi- 
cable diseases  within  the  native  population,  or  in  the 
command.  The  situation  of  the  campsite,  with  re- 
gard to  protection  from  prevailing  winds  or  expo- 
sure to  desirable  breezes ;  proximity  to  insect  produc- 
ing streams,  swamps,  or  collection  of  decomposing 
organic  matter ;  possibility  of  flooding  in  wet  weath- 
er ;  or  dust,  or  sand  storms  in  the  dry  season ;  pre- 
valence of  fogs,  and  nearness  to  potable  water  and 
other  supplies  in  sufficient  quantity ;  and  accessabili- 
ty  to  transportation,  must  be  given  due  weight. 
Poor  drainage  or  a  high  level  of  ground  water  will 
not  only  affect  the  comfort  of  the  command  by 
keeping  them  constantly  damp  and  possibly  cold, 
but  will  actually  conduce  to  transmission  of  infec- 
tions, by  interfering  with  disposal  of  waste,  and  may 
produce  collections  of  water  sufficient  to  produce 
breeding  of  disease  carrying  insects — aside  from  the 
material  damage  done  to  equipment  and  dispositions. 

Soil  conditions  such  as  presence  of  a  high  con- 
tent or  organic  matter,  or  clay,  conducing  to  reten- 
tion of  moisture,  fine  sand,  to  the  extent  of  dustiness, 
are  objectionable  and  unhealthy  and  should  be 
avoided. 

Rank  vegetation  on  a  campsite  furnishes  shelter 
for  insects,  prevents  drying  of  soil  sufficient  to  per- 
mit a  dry  camp  or  bivouac,  collects  dew  and  rain, 
and  in  general  indicates  a  high  organic  content  and 
high  ground  water,  and  should  be  avoided,  or  if  time 
permits,  eliminated.  Excessive  shade  produces  the 
same  conditions  that  does  rank  vegetation  and 


—115— 

should  be  avoided.  Campsites  should  in  general,  be 
in  the  open,  not  only  to  give  the  soil  the  benefit  of 
the  drying  effects  of  the  sun,  but  also  that  most  im- 
portant effect,  disinfection.  Shade  is  as  valuable 
and  enjoyable  for  the  soldier  as  for  any  one  else  and 
shade  trees  in  the  vicinity  of  a  camp  in  the  summer 
season  are  highly  desirable,  but  given  the  choice  of 
canvas  under  the  sun  or  shade,  choose  the  sun. 

Careful  examination  of  the  history  of  cholera 
and  typhoid  in  the  military  service  has  forced  the 
conclusion  that  commands,  camping  on  sites  former- 
ly occupied  by  infected  contingents,  have  frequently 
derived  their  infection  by  occupation  of  old  sites, 
and  has  led  to  the  avoidance  of  these,  wherever 
possible.  Experience  with  typhoid  in  our  own  ser- 
vice during  the  Spanish  War,  that  of  the  English  in 
the  Boer  War,  and  that  of  the  Germans  in  the  Fran- 
co-Prussian War  has  led  to  this  conclusion,  which 
was  confirmed  by  bacteriological  investigation  of  the 
soil  and  water  supply.  The  presence  of  disease 
carrying  insects  must  be  considered  with  the  medical 
history  of  the  vicinity  of  the  camp ;  such  history  can 
usually  be  elicited  by  questioning  the  people  living 
in  the  neighborhood,  or  consulting  town  registers, 
or  health  officers,  with  regard  to  the  prevalence  of 
typhoid  fever,  cholera,  dysentery,  malaria,  yellow- 
fever,  dengue,  typhus  and  cerebro-spinal  meningitis. 

Typhus  is  a  disease  which  we  need  not  consider 
ordinarily  in  the  United  States  but,  since  the  con- 
stant prevalence  of  an  attentuated  form  in  New 
York  has  been  proven  by  Brill  and  confirmed  by  the 
discovery  of  the  causative  micro-organism  and  meth- 
od of  transmission  by  the  body  louse,  this  disease, 
always  present  in  Mexico,  must  be  of  military  in- 
terest. This  particularly  in  view  of  its  appearance 
in  some  European  Armies,  under  good  sanitary  con- 


—116— 

trol,  in  the  present  war.  Presence  of  insects,  such 
as  fleas,  mosquitos,  ticks,  and  bugs,  and  lice,  must 
not  only  be  considered  from  the  standpoint  of  disease 
carriers,  but  also  from  consideration  of  personnal 
comfort ;  for  while  the  buffalo  gnat,  the  black  flies, 
the  Canadian  flies,  and  the  various  midges,  and  deer 
flies,  may  not  be  as  yet  implicated  in  the  carriage  of 
diseases,  their  presence  in  considerable  number  not 
only  will  worry  a  command  to  the  point  of  complete 
loss  of  rest,  but  they  may  materially  affect  the  ani- 
mal transportation.  Investigation  of  the  water  sup- 
ply will  be  made  by  gross  examination,  as  to  color, 
odor,  taste,  with  a  survey  of  the  source,  water-shed, 
with  an  inquiry  as  to  the  history  and  use  of  the 
water  and  natives  using  it ;  and,  if  time  and  appara- 
tus be  at  hand,  a  chemical  and  bacteriological  exam- 
ination. The  quantity  must  be  measured,  and  esti- 
mation of  the  amount  required  by  the  command 
must  be  made- on  the  basis  of  the  need,  for  the  type, 
and  duration  of  the  camp,  and  the  character  of 
methods  of  distribution  and  sanitary  installations. 
The  food  supply  will  also  be  investigated  on  the  same 
basis  as  is  that  of  the  water,  particular  attention 
being  given  to  milk  and  beverages,  and  method  of 
handling.  The  quantity  of  the  local  food  supply 
will  be  investigated  with  view  to  procurement  of 
special  diet  articles  for  use  of  the  sanitary  estab- 
lishments, as  will  also  the  quality,  quantity,  and 
location  of  wood,  straw,  and  forage — items  essential 
to  the  comfort  of  the  sick  at  all  times  and  to  the 
whole  command  in  inclement  weather,  when  a  time- 
ly certificate,  given  by  the  medical  officer  to  the 
quartermaster,  may  result  in  the  avoidance  of  a 
materially  increased  sick  report. 

The  investigation  of  means  of  shelter  and  trans- 
portation and  condition  and  direction  of  roads,  may 


—117— 

later  have  an  important  value  in  the  location  of  sani- 
tary units  and  the  evacuation  of  the  wounded ;  and 
should  not  be  neglected  by  the  medical  officer,  sent 
in  advance,  as  he  will  usually  have  time  and  oppor- 
tunities to  survey  the  country  before  it  is  occupied 
by  troops,  and  can  acquire  a  much  better  idea  of  the 
general  conditions,  than  officers  arriving  later. 

Having  reported  the  results  of  his  sanitary  sur- 
vey of  the  campsites,  the  sanitary  inspector  will 
consult  with  the  advance  quartermaster  as  to  distri- 
bution of  water  guards  and  water  supply  or  distri- 
bution points,  and  location  of  unit  camps,  in  order 
to  prevent  contamination.  In  large  units,  ordinarily 
a  special  quartermaster  and  sanitary  officer  will  be 
detailed  for  selection  of  the  site,  the  march  camp, 
or  permanent  camp,  and  they  should  co-ordinate 
their  duties  as  much  as  possible  on  the  basis  of  prac- 
tical efficiency. 


Sanitary  Routine 

Given  the  campsite  selected,  and  the  various  in- 
vestigations completed,  the  sanitary  inspector  re- 
ports the  results  to  the  commanding  officer,  or  the 
chief  surgeon,  if  there  be  one.  If  the  camp  is  to  be 
a  permanent  one,  the  sanitary  service  concerns  itself 
with  the  supervision  of  the  various  sanitary  estab- 
lishments of  the  details  of  the  handling  and  periodi- 
cal examination  of  the  water  supply,  the  disposal  of 
waste  water,  and  wastes  such  as  human  and  animal 
discharges,  kitchen  wastes,  the  examination  of  the 
food  supply  and  its  preparation,  the  investigation 
of  the  health  and  habits  of  the  command;  the  pre- 
vention of  disease,  and  the  care  and  evacuation  of 
the  sick,  and  the  organization  and  training  of  the 
sanitary  personnel. 


—118— 

Orders  concerning  the  special  detail  of  the  sani- 
tation of  the  particular  camp  are  recommended,  and 
periodical  inspection  is  made,  both  by  the  general 
sanitary  inspector  of  the  camp,  and  also  by  the 
senior  medical  officer.  Special  sites  for  the  camps 
of  divisional  sanitary  units  are  arranged  for,  and 
camp  hospitals  are  established.  Camp  hospitals  are 
a  revived  feature  of  our  service,  the  particular  func- 
tion of  which  is  to  care  for  the  temporarily  or  semi- 
permanently ill,  pending  evacuation,  in  order  to  pre- 
vent the  field  hospitals  from  becoming  immobil- 
ized with  disabled  and  thus  lose  the  freedom  of 
action  necessary  for  training  or  movement  with  the 
combatant  organization  to  which  attached.  The 
camp  infirmary  will  be  situated,  where  a  camp  con- 
forms to  the  scheme  laid  down  in  the  diagram  in 
field  service  regulations,  in  such  a  position  as  to  per- 
mit ready  access  from  all  of  the  regiments  of  the 
brigade  to  which  attached,  and  with  personnel  as- 
signed by  the  senior  medical  officer  of  the  brigade 
from  the  regiments  which  the  infirmary  serves ;  and 
will  be  available  as  a  collecting  point  for  temporary 
treatment  and  evacuation  of  the  sick.  During  occu- 
pation of  the  camp,  the  ambulance  companies  will 
be  available  for  the  transportation  of  the  sick  from 
the  camp  infirmaries  to  the  camp  hospital,  and  from 
there  to  the  evacuation  transport  head,  if  the  com- 
mand is  not  under  campaign  conditions  or  the  dis- 
tance too  far.  In  such  case  the  line  of  communica- 
tions, if  they  exist,  will  be  called  upon  to  perform 
evacuation  from  the  camp  hospital.  The  regimental 
sanitary  personnel  will,  in  the  permanent  camp, 
busy  themselves  with  the  physical  examination  of 
the  command  with  respect  to  their  general  physical 
condition  and  freedom  from  disease,  and  fitness  for 
the  field,  with  the  examinations  of  recruits,  the  ad- 


—119— 

ministration  of  prophylactics  for  prevention  of  infec- 
tious diseases,  and  the  examination  and  the  care  of 
the  sick  and  the  sanitary  inspection  of  the  campsite, 
and  environs  of  the  command  to  which  attached,  and 
the  instruction  of  the  sanitary  personnel  in  their 
duties,  and  the  officers  of  the  combatant  units  in 
the  first  aid  and  personal  hygiene. 

For  purposes  of  instruction  and  duty  the  regi- 
mental sanitary  personnel  may  be  divided  into 
squadron  or  battalion  sections  as  outlined  in  pre- 
vious lectures.  With  this  system  in  use,  sick  call 
will  be  held  in  each  battalion  by  the  medical  officer 
on  duty  with  the  battalion  assisted  by  the  noncom- 
missioned officer  on  duty  with  the  battalion  section 
and  a  memorandum  sick  report  sent  to  the  regi- 
mental surgeon,  together  with  such  sick  as  require 
treatment  not  afforded  by  the  personal  equipment. 
The  battalion  sick  reports  will  be  consolidated  and 
the  sick  requiring  special  treatment  or  evacuation 
will  be  sent  to  the  camp  infirmaries. 

As  a  routine,  ambulance  detachments  will  visit 
the  camp  infirmaries  twice  daily,  and  specially  in 
emergency,  and  clear  them  to  the  camp  or  field  hos- 
pitals. For  emergency  duty  in  treatment  of  the 
sick,  etc.,  one  battalion  sanitary  personnel  unit  will 
be  detailed  for  duty — the  medical  officer  being  re- 
quired to  act  as  regimental  sanitary  inspector  for 
the  day ;  to  attend  to  emergency  calls  and  examina- 
tions, such  as  the  examination  of  recruits,  etc.,  the 
enlisted  personnel  assisting  in  this  work,  night 
nursing,  etc.,  in  addition  to  their  routine. 

The  duty  tour  for  the  emergency  squad  is  usu- 
ally 24  hours,  during  which  time  they  will  remain 
in  the  vicinity  of  the  regimental  sanitary  equipment 
and  camp.  The  emergency  officer  will  mark  his 
tent  by  a  red  cross  guidon  by  day,  and  a  green  Ian- 


—120— 

tern  at  night,  so  that  his  whereabouts  may  be  known, 
and  will  notify  the  emergency  sergeant  of  his  where- 
abouts, if  it  is  necessary  that  he  leave  the  vicinity  of 
his  duty  and  assignment. 

Each  medical  officer  will  form  a  sanitary  squad 
of  his  battalion  unit  and  will  be  held  responsible  by 
the  surgeon  for  the  sanitary  inspection  and  condition 
of  the  area  assigned  to  his  battalion.  The  sanitary 
squads  will  be  responsible  for  the  sterilization  or 
treatment  of  the  water  for  their  battalion  and  the 
supervision  of  the  details  of  disposal  of  wastes,  sani- 
tary police  of  the  area,  including  drainage  and  oil- 
ing of  pools,  policing  of  latrines,  and  abolition  of 
sanitary  nuisances. 

The  battalion  surgeon  will  observe  the  condition 
of  the  battalion  personnel  as  to  health,  habits,  cloth- 
ing, and  food  suppy,  making  frequent  inspections 
of  meals ;  wrill  be  charged  with  the  physical  examina- 
tion of  the  personnel  under  his  charge  and  will  be 
authorized  to  make  direct  recommendations  to  the 
battalion  or  company  commanders,  concerned,  for 
the  betterment  of  sanitary  conditions  in  accordance 
with  the  policy  laid  down  by  the  regimental  surgeon. 

The  division  of  duty  in  this  manner  does  not 
relieve  the  regimental  surgeon  from  responsibility 
or  duty  in  this  connection,  as  he  should  make  daily 
sanitary  inspections  of  the  camp  and  command,  but 
permits  more  rapid  amelioration  of  sanitary  condi- 
tions and  gives  each  medical  officer  a  definite  per- 
sonnel and  unit  to  which  he  is  attached.  Such  con- 
tinuity of  duty  gives  the  medical  officer  a  closer 
knowledge  of  the  individuals  under  his  care  and 
supervision,  and  produces  the  best  results  in  medical 
and  general  service. 

The  enlisted  sanitary  personnel  become  ac- 
quainted with  the  individuals  of  the  battalion,  with 


—121— 

which  they  are  on  duty  and  are  able  to  furnish  val- 
uable information,  both  to  the  combatant  personnel 
as  to  sanitary  proceedings,  and  to  the  medical  officer 
as  to  the  habits  of  the  men  as  affecting  their  general 
status.  Sick  call  held  in  the  battalion  area  instead 
of  at  the  regimental  aid  station,  will  be  finished 
without  loss  of  time,  and  will  generally  carry  less 
malingering  to  escape  fatigue  duties ;  the  service  is 
brought  to  the  men,  by  an  officer  who  knows  them, 
under  conditions  which  will  exist  more  or  less  in 
campaign  for  which  all  are  being  trained. 

The  sanitary  inspections  of  the  camps,  kitchens, 
latrines,  incinerators,  dumps,  etc.,  will  be  made  at 
such  an  hour  that  will  permit  completion  of  the  rou- 
tine police  of  these  installations,  in  order  to  give  an 
idea  as  to  the  character  of  this  work ;  and,  in  order 
that  this  may  be  properly  accomplished,  the  general 
sanitary  order  must  fix  a  time  for  the  completion 
of  this  police.  Inspections  will  also  be  made  at  odd 
times  in  order  to  gain  information,  as  to  whether 
the  maintenance  of  this  police  through  the  entire 
day  is  satisfactory.  Ordinarily  the  battalion  sur- 
geons will  accompany  the  regimental  surgeon  on  his 
tour  through  their  areas;  and  the  regimental  sur- 
geon will  accompany  the  camp  sanitary  inspector 
through  the  regiment.  At  these  inspections,  sani- 
tary defects  will  be  noted,  and  memoranda  made  by 
the  interested  medical  officers.  The  medical  officers 
responsible  for  the  areas  found  defective  will  report 
them  to  the  combatant  officer  responsible,  with  sug- 
gestions as  to  correction,  and,  if  thought  necessary 
to  the  commanding  officer  of  the  unit,  either  verbally 
or  in  writing.  Frequently  camp  or  regimental  or- 
ders require  corrections  of  defects  reported  by  a  san- 
itary inspector  without  requiring  reference  to  the 
camp  or  regimental  commander,  and  it  is  customary 


—122— 

to  invite  attention  of  regimental,  battalion,  or  com- 
pany commander  to  sanitary  defects  that  require 
only  local  action,  without  making  special  report  to 
higher  authority,  making  written  note  of  such  ac- 
tion. Such  direct  methods,  if  carried  out  in  proper 
manner,  prevent  delays,  and  ordinarily  accomplish 
the  results  most  satisfactorily. 

The  first  sanitary  inspection  occurs  in  the  fixed 
camp  in  the  morning  usually  about  9-00  o'clock,  an 
hour  at  which  routine  police  of  kitchens,  streets, 
latrines,  picket  lines,  and  areas,  is  usually  completed, 
leaving  the  remainder  of  the  morning  for  adminis- 
trative duties  and  instruction.  At  this  time  will  oc- 
cur the  bi-weekly  physical  examination  of  the  com- 
mand, usually  in  the  company  streets,  by  the  medical 
officers  combined,  moving  from  one  battalion  to  an- 
other, in  order  to  perform  this  duty  as  rapidly  as 
possible  with  least  exposure.  In  camps  where  it 
is  difficult  to  secure  security  from  observation,  it  is 
well  to  fix  a  time  of  assembly,  immediately  after 
i^veille  for  this  purpose,  at  which  time  there  is  suffi- 
cient light  and  freedom  from  visitors;  but  in  bad 
weather,  inclined  to  be  chilly,  an  hour  nearer  noon 
is  advisable. 

The  administration  of  prophylactics  by  hypo- 
dermic injection,  will  usually  be  done  in  mobiliza- 
tion camps,  at  camp  or  field  hospitals,  in  pre- 
paration for  field  service ;  but  exposure  to  special  di- 
seases may  require  administration  in  the  field.  This 
will  usually  be  done  by  combining  all  available  equip- 
ment and  marching  sections  of  the  command,  to  the 
camp  infirmaries,  or  if  the  command  be  small  to  the 
aid  point;  prophylactics  for  prevention  of  venereal 
diseases  will  be  available  at  the  organization  sani- 
tary aid  point. 

In  camps  of  instruction  and  mobilization,  drill 


—123— 

and  instruction  should  be  carried  out  thoroughly, 
and  the  regimental  surgeon  will  not  only  instruct  the 
sanitary  troops  proper  in  their  duties  in  camp, 
march,  and  combat,  but  will,  if  authorized,  have  the 
band  participate  with  the  sanitary  troops  in  this 
instruction.  The  band  is  an  essential  aid  to  the 
sanitary  service  in  combat  and  must  not  only  re- 
ceive drill  and  instruction  for  this  service,  but  with 
the  sanitary  service,  receive  special  physical  train- 
ing to  prepare  them  for  the  severe  effort  which  will 
be  required  of  them.  Neither  the  duties  of  the  per- 
sonnel of  the  band,  or  of  the  Hospital  Corps  in  time 
of  peace,  give  them  the  physical  fitness  that  litter 
carriage  requires  and  the  requirements  of  combat 
will  find  them  inefficient,  unless  this  is  done. 

The  entire  command  must  be  instructed  in  the 
hygiene  of  the  individual,  and  of  the  camp,  march, 
and  battle,  and,  while  the  regulations  require  in- 
struction by  the  company  officers,  it  is  thought  best 
that  in  preparation  for  campaign,  this  instruction 
be  given  the  regimental  medical  officers,  who  are 
especially  qualified  in  this  work.  The  command 
should  be  instructed  in  the  construction,  use  and 
police  of  the  various  devices  required  in  the  sanita- 
tion of  the  permanent  or  the  march  camp,  and  one 
definite  system  should  be  constructed  and  demon- 
strated for  each  condition.  At  present  so  many 
types  of  camp  sanitary  installations  are  used  that 
much  confusion  results.  Most  of  these  devices  are 
good,  but  many  of  the  best  require  so  much  labor, 
material,  and  time  in  their  preparation,  that  their 
construction  and  use  as  a  means  of  camp  sanitation 
is  inadvisable.  In  order  to  attain  some  idea  of 
standard  measures  or  devices  for  camp  sanitation, 
these  will  be  discussed  as  briefly  as  possible. 


—124— 

Water  Supply 

Amount  required  depends  upon  type  of  camp, 
method  of  distribution  or  supply,  sanitary  installa- 
tions, and  weather.  Camps  with  piped  supply  to 
company  kitchens,  shower  baths,  and  water  car- 
riage sewer  system  in  hot  weather  will  require  25 
gallons  per  diem  for  each  man  and  ten  gallons  for 
each  animal.  Bivouacs  and  march  camps  will  re- 
quire a  minimum,  one  gallon  for  each  man  for  drink- 
ing and  food,  aild  from  five  to  seven  gallons  to  each 
animal.  This  where  water  must  be  carried  by  hand 
for  personal  and  kitchen  use,  and  the  animals  taken 
to  it.  For  purposes  of  ablution  and  kitchen  service, 
this  must  be  increased  by  at  least  three  gallons  per 
man.  Requirements  of  procurement  from  natural 
.containers  as  streams,  ponds,  springs,  and  wells, 
will  require  designation  of  special  points  for  pro- 
curement for  water  for  drinking,  cooking,  and  for 
use  of  animals,  and  washing  and  bathing,  in  order 
to  prevent  pollution  and  soiling;  and  guards  to  en- 
force the  regulations.  These  arrangements  will  be 
made  in  advance  as  mentioned  above  and  required 
by  Field  Service  Regulations,  240 ;  and  consideration 
given  as  to  the  most  available  means  of  storage  and 
disinfection,  if  such  be  found  necessary. 

Means  for  storage  must  be  taken  in  case  of  in- 
sufficient supply  early  before  time  of  expected  use, 
ordinarily  improvised  from  materials  at  hand.  In 
the  choice  of  these  materials  care  must  be  taken  that 
these  are  sufficiently  clean  for  the  purpose,  and  if 
there  is  any  doubt  of  the  purity  of  the  water  or 
storage  containers,  measures  of  disinfection  must 
be  arranged  for.  At  the  present  date  there  are  three 
methods  by  which  this  may  be  accomplished  with 
equipment  at  hand  or  improvised  in  march  camps 
or  bivouacs.  Boiling  in  individual  or  organization 


—125— 

containers,  precipitation  with  chemicals  and  filtra- 
tion with  the  various  types  of  filters,  or  sterilization 
by  chemicals  in  special  containers.  Of  these  the  tin 
cup  and  canteen,  or  the  company  kettles  serve  for 
boiling;  for  precipitation  and  filtration  the  Darnall 
filter  as  issued  is  satisfactory;  and  for  chemical 
sterilization  the  Lyster  water  bag  serves  most  satis- 
factorily, on  account  of  ease  of  transport  and  reliabi- 
lity. The  Lyster  bag  is  now  a  part  of  the  company 
equipment.  The  last  two  methods,  however,  require 
special  equipment  and  are  not  always  at  hand. 
Where  possible  the  matter  of  water  ^  sterilization 
should  be  turned  over  to  the  sanitary  service,  in 
order  to  give  it  responsible  supervision,  and  can 
ordinarily  be  handled  by  the  battalion  sanitary  de- 
tachment, if  it  is  afforded  transportation  or  aid 
for  procurement  and  delivery.  It  can  be  considered 
as  constantly  true  that  water  from  the  average 
stream  or  pond  in  any  moderately  populated  area 
is  infected  and  will  require  sterilization.  If  this  is 
so,  some  special  sterilization  apparatus  will  be  ne- 
cessary. Of  these  the  most  efficient,  bulk,  weight, 
and  delivery  considered,  is  the  bag  with  the  chemical 
agents. 

For  permanent  camps  the  water  should  be  de- 
livered in  such  a  manner  that  it  will  not  require 
treatment  by  the  troops  and,  if  such  action  is  neces- 
sary, treatment  must  be  done  at  a  central  plant,  un- 
der proper  direction  and  control,  with  the  usual  bac- 
teriological checks  by  a  laboratory  designated  for 
this  purpose. 

Care  must  be  taken  in  camps  supplied  by  pipe 
to  prevent  waste  and  give  sufficient  drainage  about 
points  of  delivery.  It  cannot  be  too  much  impressed 
upon  organization  commanders  that  wells,  as  sources 


—126— 

of  water  supply,  cannot  but  be  regarded  with  sus- 
picion with  regard  to  capacity. 

Ordinarily  there  is  at  hand  no  method  of  judg- 
ing capacity  except  by  the  testimony  of  inhabitants. 
The  demands  of  a  single  family  or  group  of  families 
upon  a  given  well  is  usually  so  small  that  the  ordi- 
nary well  gets  a  reputation  for  inexhaustibility. 
The  first  15  minutes  or  half  hour  after  the  arrival 
of  a  regiment,  finds  the  water  taken  from  the  two 
or  three  wells  available,  roily,  and  another  quarter 
of  an  hour,  frequently  finds  them  exhausted.  If 
they  are  not  exhausted  the  constant  demand  has 
brought  in  surface  water,  too  rapidly  filtered  through 
the  earth  to  insure  precipitation  or  nitrification,  and 
as  a  result  we  find  the  neighborhood  privy  vault, 
cesspool,  or  barnyard  puddle  contributing  its  moiety 
to  the  liquid. 

The  average  regiment  can  wreck  a  pump,  curb 
and  casing  in  half  an  hour,  and,  if  method  of  removal 
is  not  regulated  and  controlled,  pollute  the  well 
contents  by  drippage  from  dirty  boots  within  that 
time.  The  essentials  for  preservation  of  a  well  and 
its  equipment  is  a  guard  who  will  require  that  no 
vessel  smaller  than  a  bucket  is  filled  at  the  well  and 
that  the  method  of  removal,  proceed  carefully  under 
his  control  without  wastage,  and  that  no  refilling  be 
done  within  forty  feet  of  the  well,  and  that  removed 
from  trails  which  would  lead  to  muddying  and  soil- 
ing of  the  curb. 

An  almost  indispensable  equipment  for  the  pro- 
curement of  water  for  a  battalion  or  regiment  in 
campaign  is  a  horizontal  marine  pump,  with  50  feet 
of  three-inch  suction  and  25  feet  of  delivery  hose. 
Such  an  apparatus  is  relatively  indestructible  and 
will  give  sufficient  delivery  for  the  command  without 
soiling  of  the  source  of  supply.  It  can  be  controlled 


—127— 

by  one  sentry,  and  worked  by  the  company  water 
detail.  After  a  command  is  trained  to  its  use,  no 
sentry  is  required  other  than  for  general  patrol  of 
the  general  water  supply  line. 

Food  Supply 

The  sanitary  service  will  examine  the  food  sup- 
ply from  all  sources  with  regard  to  its  quantity, 
quality,  source,  methods  of  handling  and  prepara- 
tion, this  by  inspection  of  the  quartermaster  issues, 
method  of  transport  to  the  organizations  and  care 
and  storage  therein.  Company  kitchens  and  messes 
will  be  inspected  with  regard  to  their  cleanliness, 
the  method  of  storage  and  handling  food,  and  the 
personnel  of  the  kitchen  will  be  scrutinized,  with 
regard  to  possibility  of  their  being  carriers  of  in- 
fectious diseases. 

Under  the  stress  of  march  conditions  and  the 
necessity  of  local  purchases  the  especial  care  in  ex- 
amining food  supplies,  that  is  used  in  time  of  peace 
may  not  be  used,  and  the  supply  from  the  quarter- 
master must  be  as  carefully  inspected,  as  that  offered 
for  sale  from  civil  sources.  Inspection  of  abattoirs, 
storage  plants,  butcher  shops,  groceries,  and  dairies 
furnishing  supplies  must  be  made  and  action  be 
taken  to  prevent  entrance  into  camp  of  supplies  from 
non-inspected  and  unsanitary  sources.  The  general 
provision  that  articles  shall  not  be  offered  for  sale 
within  the  camp  limits  except  at  authorized  estab- 
lishments, under  military  control,  will  materially 
limit  consumption  of  unsanitary  foods,  and,  under 
proper  conditions  the  visiting  of  unsanitary  estab- 
lishments may  be  forbidden.  With  large  forces  the 
use  of  a  mobile  laboratory,  will  materially  aid  the 
work  of  examination  of  food  and  water  supply. 
Such  organizations  are  a  feature  of  the  sanitary  ser- 


—128— 

vice   of  all  European  Armies   and   are   authorized 
and  have  been  used  in  our  own. 

Disposal  of  Wastes 

Like  the  water  supply  the  methods  of  disposal 
of  wastes  of  camps  are  dependent  upon  permanency, 
purpose,  and  supply  of  the  camp,  the  environs,  char- 
acter of  the  soil,  the  drainage,  and  the  appropria- 
tion available;  and  the  individual  who  adapts  his 
methods  to  these  conflicting  conditions  wrill  accom- 
plish the  best  results. 

Permanent  camps  and  cantonments  will  un- 
doubtedly save  in  the  long  run  by  installing  a  proper 
water  carriage  system,  for  disposal  of  body  dis- 
charges, and  liquid  wastes,  but  ordinarily,  the  ini- 
tial expense  is  too  great,  in  consideration  of  the 
allotments,  for  this  purpose.  The  danger  of  produc- 
tion of  epidemic  diseases  by  insect  carriage  from 
human  discharges,  as  proven  within  the  last  twenty 
years,  has  caused  the  adoption  of  many  expedients 
for  the  proper  disposal  of  f eces,  urine,  and  garbage ; 
aimed  at  prevention  of  contact  with  or  breeding  of 
flies  in  wastes.  These  vary  from  destruction  of 
wastes  by  fire  to  storage  and  disinfection. 

Destruction  of  human  wastes  by  fire  is  un- 
doubtedly an  ideal  method,  but  it  has  been  found  ex- 
pensive, and  the  various  incinerators  used  have  been 
so  bulky  and  heavy,  that  it  is  only  adapted  to  fixed 
or  permanent  camps  and  cantonments ;  and  there  are 
other  less  expensive  means  that  have  been  found  ef- 
fective. The  average  initial  cost  per  seat  of  the  la- 
trine incinerator  has  been  some  forty  dollars,  and, 
while  they  have  materially  safeguarded  health,  these 
devices  have  not  been  an  unalloyed  comfort,  as  any- 
one can  testify  who  has  had  his  appetite  materially 
affected  by  fumes  from  the  stewing  contents  of  the 


—129— 

pans  carried  by  on  an  unpropitious  breeze.  Another 
objection  to  these  latrine  incinerators  is  that  in 
ordinary  camps  conditions  will  require  use  of  some 
extemporized  latrine,  usually  some  type  of  trench, 
and  troops  should  be  trained  in  their  use  and  con- 
struction under  favorable  conditions. 

The  large  camps  are  ordinarily  established  for 
purposes  of  instruction,  mobilization,  or  concentra- 
tion; usually  with  personnel  that  requires  instruc- 
tion in  general,  and  they  should  here  be  shown  the 
latrine  that  will  be  used  by  them  in  campaign.  For 
camps  of  more  than  one  day,  a  trench  of  sufficient 
width  (2  feet),  and  depth  according  to  probable 
duration  of  the  camp,  and  length  proportioned  to 
the  command  it  is  to  serve,  is  required.  Seats 
should  be  in  the  proportions  of  one  to  each  ten  men 
and  length  on  the  basis  of  2i  feet  to  each  seat. 
F.S.R.  246,  provides  for  6  feet  as  the  depth  for  per- 
manent camps,  such  depths  should  depend  upon  the 
character  of  the  soil  formations. 

Access  by  flies  must  be  prevented  by  police  with 
earth  or  other  suitable  material,  if  flylight  covers 
cannot  be  made,  and  some  means  of  support  such  as 
the  pole  in  ordinary  use  should  be  provided.  It  is 
needless  to  say  that  where  possible  arrangements 
should  be  made  for  seat  covers.  In  arranging  the 
seat  hole,  it  will  be  found  an  excellent  plan  to  make 
it  sufficiently  long  from  front  to  rear,  and  this  can 
be  done  by  cutting  out  a  notch  in  the  front  and  rear 
for  the  purpose  of  preventing  contact  with  the  seat, 
at  these  points,  and  soiling  by  urine  and  feces.  A 
special  urine  trough  protected  from  flies  by  use 
of  crude  oil  should  be  provided  where  possible.  A 
very  necessary  precaution  to  prevent  flooding  is  the 
construction  of  a  ditch  or  dike  well  away  from  the 
trench  to  prevent  access  by  storm  water.  The  burn- 


\ 


—130— 

ing  of  oil  and  straw  or  similar  material  does  not  ac- 
complish disinfection  to  any  extent,  but  does  de- 
stroy fly  eggs  laid  on  the  surface  and  furnishes  a 
layer  of  oily  ashes  and  soot,  which  cover  the  sur- 
face and  walls  of  the  pit  and  renders  it  repugnant 
to  flies.  A  growing  practice  in  burning  out  of  la- 
trines is  to  do  this  without  removing  the  box.  This 
method  prevents  the  constant  removal  of  the  box, 
with  necessity  for  closing  up  crevices  and  fills  the 
interior  and  all  cracks  with  a  smoky  soot,  that  serves 
to  keep  flies  away.  If  properly  handled  the  boxes 
and  shelter  will  not  be  burned.  The  only  objection 
to  this  method  is  that  the  seats  become  smoked  and 
blackened  and  are  unsightly. 

Straddle  trenches  of  the  width  of  a  spade,  the 
length  of  a  spade  and  handle,  and  the  depth  of  half 
of  the  length  of  a  spade  and  handle  are  provided 
for  one  night  march  camps,  these  are  provided  in  the 
proportion  of  one  to  ten  men,  and  should  be  placed 
parallel  to  each  other,  with  long  axis  parallel  to  the 
company  street,  at  a  considerable  distance  away,  so 
as  to  permit  construction  of  new  trenches  if  neces- 
sary nearer  the  company  in  order  that  filled  trenches 
may  not  be  traversed  in  going  to  new  ones.  The 
earth  removed  should  be  thrown  to  the  end  nearest 
the  company,  instead  of  on  the  long  sides  and  used 
for  policing.  The  psychology  of  the  use  of  the  strad- 
dle trench  is  interesting.  All  latrines  should  be 
located  and  drained  in  such  a  manner  as  to  prevent 
pollution  of  the  water  supply. 

In  permanent  camps  urine  cans  should  be  used 
in  the  company  streets,  between  darkness  and  re- 
veille, to  prevent  pollution  of  the  camp  ground.  The 
garbage  cans  used  for  this  purpose  should  be  re- 
moved and  emptied  immediately  after  reveille  in  the 
latrine  for  this  purpose,  and  burned  out  and  sunned. 


—131— 

Lights  should  be  kept  burning  in  the  latrines  and  at 
the  urine  cans  during  darkness. 

In  addition  to  the  means  for  disposal  of  human 
discharges  given,  the  Reed  trough,  with  the  so-called 
odorless  excavator  have  been  used  at  times.  These 
have  been  found  ditry  and  objectionable,  besides 
liable  to  disarrangement.  In  permanent  camps  with 
high  ground  water,  as  found  on  the  coast  or  in 
river  villages,  difficulty  will  be  found  with  trench 
latrines ;  here  a  dry  earth  system  will  be  found  the 
least  expensive  in  actual  cost;  but  here  as  well  as 
with  the  Reed  trough,  objection  on  account  of  liabil- 
ity of  scattering  removed  material,  can  be  raised. 

Kitchen  waste  of  permanent  camps  or  semi- 
permanent'camps  is  best  disposed  of  by  incinerators, 
preferably  in  the  camp  kitchen  incinerator,  which  if 
properly  constructed  and  administered  will  dispose 
of  all  dry  and  liquid  garbage  of  the  company  includ- 
ing waste  proper  and  sweepings.  The  essentials  of 
this  sanitary  installation  are  simplicity  of  construc- 
tion and  management,  with  efficiency  and  economy 
of  fuel.  Various  devices,  such  as  the  beehive,  the 
Alamo,  and  many  others  have  been  used  and  all  have 
merit;  but  most  of  them  require  considerable  time, 
labor,  and  special  material,  and  have  not  the  almost 
universal  applicability  of  the  simpler  forms.  Of 
these,  probably  the  simplest  is  a  trench  5  feet  long, 
2J  feet  wide  and  one  foot  deep,  filled  with  stones 
thrown  in  loosely  to  the  ground  level.  On  the 
long  side  of  the  trench,  stone  walls  one  foot  high  and 
eighteen  inches  wide  are  placed  and  backed  by  earth, 
such  a  trench  will  accommodate  two  or  three  sticks 
of  cord-wood  and  if  kitchen  liquids  are  poured  over 
the  stones  on  the  sides  and  ends,  in  small  amounts, 
from  time  to  time,  will  consume  these  and  all  of  the 
relatively  dry  garbage  of  the  company.  The  ends 


132 

are  left  open  for  the  removal  of  debris,  draught,  and 
the  placing  of  wood.  Experiments  have  shown  that 
sufficient  heat  for  evaporation  from  an  ordinary  fire 
penetrates  the  stone  bed,  only  to  the  distance  of  one 
foot,  and  additional  depth  is  not  only  a  waste  of  labor 
but  objectionable  in  that  it  creates  a  layer  of  un- 
destroyed  putrescent  material  at  the  bottom  of  the 
trench.  The  stones  selected  for  use  in  these  incin- 
erators should  be  about  8  or  10  inches  in  diameter 
and  as  fire  resistant  as  possible.  These  incinerators 
owing  to  destruction  of  the  stone  by  heat  and  water 
require  reconstruction  from  time  to  time.  For  a 
company  of  ordinary  size,  larger  pit  incinerators  are 
unnecessary  and  wasteful  of  fuel.  The  incinerator 
trench  should  be  diked  or  ditched  to  prevent  flooding. 

In  addition  to  the  ordinary  garbage,  tin  cans 
should  be  well  burned  out,  to  destroy  organic  matter. 
Incinerator  debris  should  be  removed  twice  daily 
and  stacked  for  removal ;  as  it  is  innocuous,  it  need 
not  be  covered. 

Experience  has  shown  that  many  difficulties  of 
administration  and  control  cause  the  larger  impro- 
vised incinerators,  made  for  use  of  battalions,  to  be 
inefficient  and  uneconomical.  The  company  incin- 
erator has  proven  its  worth,  is  subject  to  direct  con- 
trol and  should  be  used  as  a  matter  of  training. 

Kitchen  wastes  are  usually  disposed  of  in  march 
camps  and  bivouacs,  by  use  of  kitchen  sink  pits,  with 
diameter  and  depth  varied  to  suit  the  size  of  the 
command  and  the  length  of  use.  They  should  be 
policed  with  earth  and  ditched  in  a  manner  similar 
to  trench  latrines.  All  trenches  must  be  filled  and 
banked  on  breaking  camp. 

The  disposal  of  manure  and  care  of  the  picket 
lines  is  important  in  view  of  the  fact  tha  the  most 
common  source  of  flies  in  camps  are  collections  of 


—133— 

manure:  while  flies  will  breed  under  favorable  cir- 
cumstances in  almost  any  decomposing  organic  mat- 
ter, which  is  not  repulsive  or  poisonous  to  them  on 
account  of  the  contained  chemicals,  their  chief  breed- 
ing ground  is  excrement  of  animals  and  man. 

Ordinary  police  of  the  camp  is  usually  sufficient 
to  prevent,  destroy,  or  remove  ordinary  collections 
of  organic  matter,  but  the  ubiquity  of  horse  drop- 
pings, and  the  urine  soaked  ground  of  the  picket  line, 
afford  excellent  breeding  places,  which  are  promptly 
used  by  flies.  Under  ordinary  weather  conditions 
of  summer,  the  fly  matures  in  from  ten  to  fourteen 
days,  and  destruction  of  organic  material  must  occur 
within  this  lesser  limit.  In  order  to  prevent  in- 
crease of  flies ;  action*  must  be  taken  to  limit  move- 
ments of  horses  and  mules  in  the  vicinity  of  the 
camps,  to  the  limits  of  the  corral,  and  designated 
roads,  which  will  be  reguarly  policed  and  require 
special  attention  to  the  removal  of  all  droppings  in 
and  near  the  camp  area.  Action  must  be  taken  to 
designate  hitching  points  for  animals,  and  forbid 
general  entrance  to  camp  streets.  The  manure 
should  be  gathered  from  the  roads,  picket  lines,  and 
camps,  and  removed  to  a  distance  from  the  camp 
and  burned.  If  arrangement  is  made  with  civilians 
to  dispose  of  this  for  fertilizer,  care  must  be  taken 
to  see  that  it  is  removed  at  least  a  fly-flight  from 
camp,  and  preferably  spread  out  on  the  ground  it 
is  to  cover. 

Thin  layers  of  manure  will  dry  out  sufficiently, 
to  furnish  no  available  pabulum  for  larvae,  and  are 
not  objectionable.  Horse  manure,  unbroken,  is 
covered  by  a  fine  pellicle  of  mucus,  which  favors  re- 
tention of  moisture  and  development  of  larvae. 
When  this  is  broken  it  dries  quickly  and  is  unfavor- 
able soil  for  growth  of  maggots. 


—134— 

The  soil  of  stalls,  and  of  the  picket  lines  is  a 
fruitful  source  of  flies,  however  well  they  are  swept, 
as  the  maggots  find  a  hospitable  environment  and 
rich  food  supply  in  urine-soaked  earth  and  penetrate 
it  frequently  to  the  depth  of  six  inches  and  undergo 
transformation  into  the  perfect  fly  and  emerge  from 
the  burrows,  ready  to  play  their  distinct  game  of 
pussy  wants  a  corner,  between  the  camp  latrine  and 
the  soup  tureen. 

Careful  scraping  of  the  picket  line  to  the  depth 
of  an  inch  or  so,  and  thoroughly  burning  over  with 
straw  and  petroleum,  three  times  a  week,  will  de- 
stroy eggs  and  immatu  e  larvae  which  will  not  have 
penetrated  far  beneath  the  surface  in  the  short 
interval  of  time  between  burnings.  It  would  seem 
that  consideration  of  the  life  history  of  the  flies  and 
the  probability  of  the  short  duration  of  march  camps 
would  not  require  enforcement  of  the  sanitary  mea- 
sures outlined  for  disposal  of  wastes  of  camps  of  an 
impermanent  nature.  It  must  be  remembered,  how- 
ever, that  the  single  organization  represented  in  this 
camp  may  be  followed  by  others  and  the  same  con- 
siderations that  caused  the  selection  of  this  site  may 
cause  selection  by  another  in  this  vicinity ;  and  that 
the  command  must  not  only  take  the  sanitary  pre- 
cautions outlined  to  protect  themselves  now,  but  the 
other  organizations  of  the  zone  of  the  advance,  those 
of  the  lines  of  commuications,  and  the  civil  inhabi- 
tants of  the  territory  occupied  are  entitled  to  con- 
sideration. These  sanitary  measures  are  not  only 
directed  to  prevention  of  production  of  insects,  but 
also  to  the  prevention  of  carriage  of  disease  by  them. 

Many  insects  are  merely  mechanical  carriers 
of  disease,  and  a  fly,  in  being,  may  dabble  in  the  se- 
ductive delights  of  typhoid,  cholera  or  dysentery 
stool,  and  furnish  a  company  with  all  of  the  invalid- 


—135— 

ism  it  wants ;  or  transfer  glanders,  tetanus,  or  what 
not  in  the  way  of  disease,  from  soil  or  sore,  to  the 
healing  abrasion  on  the  back  of  your  hand;  or  the 
flooded  latrine  trenches  may  spill  their  uncovered 
contents  into  the  first  available  stream,  and  give  not 
only  typhoid  to  the  unvaccinated,  but  its  first  cousin, 
paratyphoid,  to  the  first  uninoculated  individual  who 
drinks  from  the  brook. 


Divisional  Sanitary  Units 

The  service  of  ambulance  companies  has  been 
outlined  in  general  for  the  camp  and  march  in  pre- 
vious lectures.  The  organizations  camp  together  in 
the  permanent,  semi-permanent,  and  march  camps, 
where  possible,  unless  they  are  separated  for  some 
special  duty,  when  those  organizations  so  separate, 
as  with  an  advance  flank  or  rear  guard,  camp  in 
advance  of  the  trains  of  the  organization  to  which 
attached.  This  on  account  of  the  fact  that  the 
nature  of  this  detachment  ordinarily  implies  like- 
lihood of  hostile  contact.  Whatever  the  nature  of 
the  duty,  they  are  camped  in  a  position  to  give 
them  ready  access  to  the  front  and  rear,  in  order  to 
facilitate  movement  on  the  execution  of  their  duties, 
usually  on  a  crossroads  giving  roads  that  lead  to 
the  various  sectors  of  the  front.  These  organiza- 
tions camp  in  column  of  companies,  as  does  artillery, 
with  a  depth  of  350  yards  and  a  breadth  of  100 
yards,  allowing  25  yards  to  a  company,  including  in- 
tervals. Accessibility  to  water  is  essential  to  these 
organizations,  owing  to  their  considerable  number  of 
animals,  78  to  each  company.  Under  march  or  war 
conditions,  the  camp  of  these  organizations  should 
be  such  as  to  permit  their  retaining  their  place  in 
the  column,  without  countermarching. 


—136— 

Aside  from  the  duties  of  evacuation  and  trans- 
portation of  the  sick  and  issue  of  medical  supplies 
to  organizations  attached  to  the  combatant  troops, 
these  units  are  in  part  charged  with  the  procurement 
of  additional  supplies  from  the  line  of  communi- 
cations and  performance  of  guard  duty  for  field 
hospitals,  besides  performing  their  own  camp  and 
stable  guard. 

Field  hospitals  in  semi-permanent  camps  have 
little  to  do  with  the  care  of  the  sick,  where  camp  in- 
firmaries and  camp  hospitals  are  present.  Their 
duties  as  outlined  in-  the  Manual  for  the  Medical 
Department,  are  the  temporary  care  of  the  disabled, 
pending  evacuation,  and  they  are  the  nightly  collec- 
ting points  on  the  march,  or  in  temporary  camps,  for 
the  individual  sick  who  are  unable  to  continue  the 
march. 

Filling  them  up  with  disabled  would  immobilize 
them  and  prevent  mobility.  In  any  camp,  no  more 
field  hospital  equipment  is  established  than  is  neces- 
sary for  the  care  of  the  sick,  and  usually  one  field 
hospital  or  part  of  a  field  hospital  is  detailed  for  this 
duty,  by  roster. 

In  march  camps  in  campaign,  field  hospitals 
ordered  to  establish,  usually  do  so,  taking  advantage 
of  such  buildings  as  are  available  to  save  time  and 
labor  of  unpacking  tentage,  and  accumulate,  as  early 
as  possible,  straw  bedding  and  special  diet  supplies, 
over  the  emergency  supplies  carried  in  preparation 
for  the  daily  increment  of  sick.  The  field  hospital 
designated  for  this  duty  can  be  marched  at  the  tail 
of  the  column,  in  order  to  permit,  early  establish- 
ment, and  will  ordinarily  be  ready  for  action  by  the 
time  the  disabled  are  brought  to  them,  the  remaining 
organizations  camp  with  the  sanitary  train,  guarded 
by  personnel  from  the  ambulance  companies.  The 


—137— 

field  hospitals,  as  well  as  the  ambulance  companies, 
carry  reserve  medical  stores,  and  will  from  time  to 
time  issue  and  refill  from  those  sent  up  from  the 
advance  depot  of  the  Line  of  Communications. 


Lecture     VI 


SANITARY  SERVICE  IN  COMBAT 

Attached  Sanitary  Troops,  Infantry,  Cavalry, 

Artillery,  Engineers,  Signal  Corps 

Sanitary  Train 

THE  duties  of  Sanitary  Troops  in  combat  are : — 
1.  Care  of  the  wounded  by  application  of  appro- 
priate measures  for  their  temporary  treatment. 

2.  The  collection  and  evacuation  of  the  wounded 
with  care  and  distribution  to  the  various  establish- 
ments according  to  the  gravity  of  their  wounds  and 
probable  duration  of  disability. 

3.  The  separation  of  the  disabled  from  the  non- 
disabled  and  action  to  return  the  non-disabled  to 
duty. 

4.  The    preparation    of    records    of   dead    and 
wounded. 

5.  The  management  of  the  Sanitary  Service  and 
the  renewal  of  sanitary  material  and  personnel  ex- 
pended. 

6.  The  examination  and  supervision  of  the  in- 
terment of  the  dead  and  the  sanitary  policing  of  the 
battlefield. 

The  necessity  for  such  a  service  is  essential  to 
preserve  morale  among  the  combatant  troops  and  to 
prevent  depletion  of  the  firing  line  by  detachment 
for  care  of  the  wounded.  F.  S.  R.  344  forbids  com- 
batants, unless  duly  authorized,  to  take  or  accom- 
pany sick  or  wounded  to  the  rear,  and,  in  the  light  of 
the  experiences  of  the  Russians  in  Manchuria,  where 
139 


—140— 

the  firing  lines  were  depleted  by  such  action,  a  provi- 
sion of  this  kind  is  necessary.  Fischer  quotes  Von 
Tetlau  as  saying:  "Of  the  Russians,  seriously 
wounded  were  carried  by  four  unwounded  soldiers 
and  followed  by  two  men  as  companions;  each  one 
who  was  wounded  in  the  leg  supported  by  two  well 
comrades,  while  a  third  carried  the  arms.  The  com- 
panions never  were  in  a  hurry  to  return  to  their 
organizations."  "Help  should  seek  the  wounded, 
not  the  wounded  help,  else  we  open  the  door  wide  for 
the  (un)  wounded  to  loaf  around." 

Attached  Sanitary  Troops 

Our  tables  of  organization  provide  four  med- 
ical officers,  four  noncommissioned  officers  and 
twenty-nine  privates  of  the  sanitary  troops  for  a 
regiment  of  infantry.  The  same  number  with  a  regi- 
ment of  cavalry ;  and  three  to  four  officers,  three  to 
four  noncommissioned  officers  and  twenty  to  twenty- 
nine  privates  with  a  regiment  of  artillery,  when  at 
maximum  strength. 

The  combat  equipment  of  these  organizations 
when  'serving  with  a  brigade  or  division  having 
mobile  sanitary  units,  consits  of  1  field  desk,  1 
box  reserve  dressings,  1  medical  and  surgical  chest, 
1  bucket,  G.  L,  1  axe,  1  tent  fly,  2  lanterns,  and  the 
personal  equipment  of  the  men  and  officers,  besides 
litters  and  boxes  of  surgical  dressings  carried  in 
the  combat  wagons. 

The  contents  of  the  field  desk  consist  of  sta- 
tionery, blank  forms,  and  books.  As  it  is  doubt- 
ful that  all  of  the  space  will  be  used  for  these  arti- 
cles, the  canny  medical  officer  may  store  dry  medi- 
cines or  dressings  in  reserve.  This  field  desk  is 
carried  on  the  regimental  headquarters  wagon. 
The  remaining  articles  except  those  of  the  personal 


—141— 

equipment  are  carried  on  the  pack  mule  for  use 
with  the  regimental  aid  station. 

This  gives  with  each  regiment,  in  addition  to 
one  1st  aid  packet  on  the  person  of  each  individual, 
an  amount  sufficient  for  first  aid  of  a  regiment  act- 
ing in  conjunction  with  mobile  sanitary  units,  and 
sufficient  for  20  %  loss. 

Should  the  regiment  be  acting  independently,  it 
will  have  available  the  contents  of  the  regimental 
hospital  equipment,  which  will  be  pushed  forward 
as  a  combined  dressing  station,  field  hospital.  The 
medical,  surgical  and  sterilizer  chests  and  food  boxes 
and  cases  will  give  much  additional  dressings,  sup- 
plies and  restoratives,  together  with  necessary  medi- 
cines, instruments,  appliances,  towels  and  bedding 
for  12  patients. 

Independent  battalions  such  as  Signal  Corps 
carry  the  aid  station  equipment.  Cavalry  and  artil- 
lery, having  a  smaller  sanitary  personnel,  do  not 
have  so  much  personal  equipment  and  dressings, 
but  have  a  sufficient  equipment  for  their  necessities. 

Of  means  for  transportation  of  patients,  the 
regimental  sanitary  personnel  has  available  litters, 
in  amount  according  to  the  organization,  carried 
by  the  sanitary  personnel  attached  to  each  battalion 
with  the  headquarters  section,  and  one  litter  belong- 
ing to  each  company  carried  in  the  combat  wagons 
or  all  carried  in  the  combat  wagons. 

In  the  infantry,  there  will  be  eventually  avail- 
able, eight  litter  squads  of  the  Medical  Department 
personnel  and  fourteen  litter  squads  of  the  band, 
provided  the  band  is  kept  to  full  strength.  Usually 
this  is  so  with  an  infantry  regiment.  The  cavalry 
will  have  at  best,  only  four  litter  squads  from  the 
Medical  Department  troops,  and  the  artillery  six, 
with  only  6  or  7  company  litters.  If  the  regiment  is 


—142— 

acting  alone  it  will  have  in  addition,  4  ambulances 
and  two  field  wagons  attached  to  the  sanitary  troops. 
The  ambulances  can  carry  four  recumbents  and  one 
sitting  or  nine  sitting  each,  and  the  wagons  four  or 
five  moderately  wounded  in  the  usual  proportions  of 
recumbents  to  sitting  3  to  5 ;  the  wheeled  transpor- 
tation can  carry  in  an  infantry  regiment  on  the 
sanitary,  combat,  and  ration  and  baggage  sections, 
field  and  combat  trains,  12  recumbents  and  100  sit- 
ting cases,  these  latter  including  the-able-to-walk, 
to  the  field  hospitals. 

Field  Wagons 


o> 
•*->  &JO  tfi 

I  &       I         -3 

I  I     1  -       i 

0         .  «  «  W 

Regiment,   Infantry,     11  5  11  27 

Cavalry, 8  13  16  37 

Artillery, 85   carriages         3  18        plenty 

As  noted  in  the  Sanitary  Service  of  the  March, 
the  position  of  the  surgeon,  the  battalion  sanitary 
personnel,  and  the  headquarters  section  of  the  san- 
itary personnel  was  that  which  placed  them  in  a 
satisfactory  situation  with  respect  to  the  command, 
either  for  the  service  of  the  march  or  combat. 

In  preparation  for  combat  the  surgeon,  up  with 
the  commanding  officer,  has  already  traversed  the 
ground  to  tohe  rear  of  the  probable  position,  and  is 
informed  as  to  the  terrain  and,  with  the  command- 
ing officer  will  examine  the  terrain  to  the  front  with 
a  view  of  determining  the  probable  positions  of  the 
combatant  troops  and  probable  covered  lines  of  com- 
munications to  the  rear  as  representing  the  course 
of  drift  of  the  wounded.  He  will  be  informed  of  the 


—143— 

plans  of  the  regimental  commander  and  in  consider- 
ation of  these  plans  will  make  recommendations  as 
to  the  probable  site  or  action  of  the  regimental  aid 
station.  Such  action  must  be  dependent  upon  the 
type  of  action  to  occur.  If  it  be  a  planned  attack, 
the  surgeon  will  select  a  tentative  site  for  an  aid 
station  and  hold  his  equipment  in  readiness,  pend- 
ing the  development  of  the  action.  This  organiza- 
tion will  not  be  needed  for  some  time  and  should  not 
be  established  until  there  is  a  definite  use  for  it. 
Changes  of  disposition  may  require  disestablishment 
and  change  of  position,  a  thing  not  difficult,  unob- 
jectionable when  necessary,  but  nevertheless  unde- 
sirable when  required  through  the  fault  of  too  early 
establishment.  A  planned  defense  permits  early 
establishment  and  notification  of  the  command  as 
to  the  position  of  the  aid  station  in  combat  orders. 

Rencontre  requires,  for  the  aid  station  and  the 
mobile  establishments,  delay  in  establishment  until 
the  positions  of  the  troops  and  the  conditions  of  the 
action  are  determined.  Usually  demands  of  wound- 
ed for  establishment  will  not  be  immediate. 

Delaying  actions  require  the  earliest  establish- 
ment and  evacuation  possible,  in  order  to  clear  the 
wounded  before  the  retreat.  Transportation,  if 
available,  should  be  pushed  up  as  close  as  practica- 
ble. Consider  using  combat  wagons  where  advance 
guard  actions  follow  the  lines  of  a  planned  attack. 

The  three  essentials  in  the  treatment  of  the 
wounded  in  modern  warfare  are : — 

1.  The  prompt  application  of  a  sterile  antiseptic 
dressing  in  such  a  manner  as  to  prevent  contact  of 
matter  to  the  wound  surface  other  than  the  sterilized 
dressings  and  to  maintain  these  dressings  on  the 
wound  to  prevent  this. 


—144— 

2.  To  describe  the  wound  and  manner  of  dress- 
ing on  the  diagnosis  tag,  attached  to  the  person 
of  the  wounded  man  in  such  a  way  that  redressing 
or  interference  with  the  first  dressing  will  not  be  re- 
quired unless  the  diagnosis  tag  justifies  or  requires 
such  action,  or  special  conditions  make  this  neces- 
sary. 

3.  To  evacuate  and  treat  the  sick  in  a  manner 
to  conserve  their  strength  to  the  greatest  possible 
extent,  with  the  least  movement  to  the  rear  possible 
according  to  their  condition. 

The  necessity  for  prompt  dressing  in  a  skillful 
manner  lies  in  the  strong  probability  that  nature 
may  care  for  a  moderate  amount  of  infective  ma- 
terial carried  into  the  wound  by  the  wounding  agent, 
but  that  it  may  succumb  to  a  larger  amount.  The 
sterile  cotton  dressings  act  as  a  filter  to  exclude  in- 
fectious agents  and  yet  permit  the  wound  to  drain 
and  dry  while  the  antiseptics  with'  which  the  dress- 
ings are  treated  form  an  unfavorable  medium  for 
the  growth  of  noxious  bacteria. 

In  addition  to  prevention  of  infection,  proper 
dressing  diminishes  loss  of  strength  through  hemor- 
rhage, and  produces  mental  rest. 

The  use  of  morphine  on  the  field  is  a  great  aid 
in  securing  freedom  from  pain  and  worry  and  de- 
creasing hemorrhage  and  shock  particularly  when 
it  may  be  impossible  to  secure  prompt  evacuation. 
The  conditions  of  action  frequently  do  not  permit 
evacuation  from  the  field  until  cessation  of  firing 
or. intervention  of  darkness. 

Tagging  is  necessary:  (a)  To  prevent  inter- 
ference with  the  wound  when  properly  dressed  on 
account  of  the  fact  that  clotting  of  blood  and  serum 
in  contact  with  the  antiseptic  in  the  dressing  forms 
an  antiseptic  seal  over  the  wound,  and  to  reopen  it 


—145— 

breaks  this  seal  and  exposes  the  injury  to  additional 
chance  of  infection  and  hemorrhage  and  may  inter- 
fere with  reparative  processes  already  started. 
Blood  soaked  dressings  in  themselves  are  not  cause 
for  change  of  dressing,  (b)  To  conserve  time  and 
energy  and  facilitate  transportation  and  record. 
The  tag  bears  the  name,  rank,  organization,  diag- 
nosis, class  of  case,  walking,  sitting  or  recumbent, 
non-transportable  —  treatment,  disposition.  Date 
and  name  of  person  caring  for  him.  They  will  be 
affixed  to  sick,  wounded,  and  dead.  The  duplicate 
retained  in  the  book,  serves  as  a  record  for  casualty 
lists,  etc.,  and  the  original,  as  a  means  of  identifica- 
tion record,  record  of  treatment,  movement,  etc., 
prior  to  admission  to  the  field  hospital,  the  first  or- 
ganization of  permanent  regulation  record,  and 
serves  as  a  pass  to  the  rear.  By  this  means,  control 
of  the  slightly  \vounded  can  be  had  and  kept  away 
from  a  dressing  station  and  field  hospitals,  and  loaf- 
ing of  wounded  and  malingering  can  be  to  a  certain 
extent  prevented. 

During  the  Russo-Japanese  War  this  loafing  and 
malingering  among  the  Russian  wounded,  was  most 
pronounced.  With  the  diagnosis  tag  properly  made 
out,  receiving  departments  of  sanitary  organizations 
may  see  at  a  glance  the  condition  of  the  patient  and 
make  proper  disposition  of  him  without  delay  and 
danger  of  reexamination,  and  change  of  dressing- 
Tags  are  affixed  by  the  n.  c.  o.  or  officer  of  the  sani- 
tary service  who  comes  in  contact  with  the  case, 
where  possible. 

In  combat  of  infantry  the  battalion  sanitary 
personnel  will  accompany  the  battalion,  using  their 
personal  equipment;  where  time  permits  before  go- 
ing into  action,  they  will  draw  additional  dressings 
and  carry  them  in  their  haversacks.  As  the  action 


—146— 

will  require  the  medical  officers  to  be  dismounted,  all 
orderlies  or  substitutes  will  depart  to  the  aid  station 
with  medical  officers'  mounts  and  will  be  available 
for  dressers  or  messengers. 

The  noncommissioned  officers  will  serve  as  as- 
sistants to  the  medical  officer  and  record  and  dress 
cases. 

The  band  in  campaign  will  ordinarily  carry 
light  instruments  and  under  authority  of  the  regi- 
mental commander  may  when  marching  in  the  pre- 
sence of  the  enemy  habitually  march  with  the  .sani- 
tary troops,  as  litter  bearers,  or,  at  the  beginning 
of  an  engagement,  be  reported  to  the  surgeon.  They 
should  have  been  well  trained  in  first  aid  and  duties 
of  litter  bearers,  and  will  be  supplied  with  company 
litters  from  the  combat  wagons  and  used  by  the 
surgeon,  as  a  bearer  section,  to  be  sent  wherever 
lies  the  greatest  need  for  their  services. 

The  sanitary  troops  (in  extended  order)  will  be 
disposed  of  in  such  a  manner  that  one  private  shall 
cover  the  rear  of  each  company  in  the  best  manner 
possible,  exposure  and  first  aid  considered,  with  or- 
ders that  they  will  keep  good  observation  and  con- 
tact with  the  organization  to  which  attached  (and 
if  possible  contact  with  the  aid  station),  whatever 
the  movements  of  the  battalion.  If  a  company. is 
detached,  the  private  covering  that  company,  must 
continue  to  do  so.  While  it  is  frequently  impossible 
to  render  first  aid  to  all  that  fall  it  is  essential  that 
sanitary  personnel  be  in  contact  with  all  troops  for 
the  sake  of  morale,  as  well  as  actual  service.  It  is 
not  intended  that  immediate  dressing  or  removal  be 
made  in  the  face  of  a  dangerous  fire,  because  few 
wounded  need  immediate  attention  so  badly  that 
the  few  individuals  of  the  sanitary  service  should 
be  sacrificed  in  the  individual  case,  when  many  more 


—147— 

valuable,  the  lesser  wounded  will  need  their  service. 
So  rare  is  the  case  that  needs  immediate  service  to 
preserve  life  that  of  1440  casualties  at  Santiago, 
none  such  existed.  The  only  type  of  case  that  re- 
quires such  attention  is  possibly  a  hemorrhage  from 
a  large  vessel,  and  ordinarily,  first  aid,  such  as  can 
be  given  on  the  firing  line,  is  of  little  avail  in  these 
cases.  Remember,  a  desperately  wyounded  case, 
while  he  should  have  all  of  the  attention  that  can 
be  given  him,  requires  and  should  have  the  least 
interference  and  movement  possible,  and  in  view  of 
results  is  not  as  valuable  an  asset  to  an  army  as  one 
of  lesser  gravity.  Under  the  ordinary  conditions  of 
combat  the  sanitary  troops  with  the  firing  line  do  not 
and  cannot  keep  up  with  the  line,  but  keep  it  under 
observation,  under  cover,  and  taking  advantage  of 
cover,  dress  all  cases  and  remove  them  to  depressions 
or  behind  obstacles  that  would  give  them  protection 
from  fire.  Here  the  wounded  of  the  battalion  will 
be  collected  at  a  point  \vhich  affords  communication 
to  the  rear,  permitting  early  evacuation  by  the  litter 
squads.  It  will  be  infrequent  that  conditions  will 
permit  early  collection. 

The  position  of  a  battalion  surgeon  will  ordinar- 
ily be  at  the  rear  of  the  center  or  inner  flank  of  the 
battalion  in  order  to  place  him  on  the  line  of  drift 
or  communication  to  the  rear,  and  as  close  up  as  fire 
and  terrain  permit.  He  will  notify  the  enlisted  san- 
itary personnel,  covering  the  companies,  of  his  posi- 
tion and  keep  in  touch  with  them  and  the  battalion. 
Should  the  battalion  be  considerably  detached  from 
the  site  of  the  aid  station,  he  will  choose  a  collecting 
point,  permitting  movement  from  the  front  and  eva- 
cuation to  the  rear,  where  he  will  collect  the  trans- 
port cases.  Slightly  wounded  cases  will  either  be 
returned  to  their  units  or  tagged  and  ordered  to  pro- 


—148— 

ceed  through  the  regimental  aid  station  to  the  sta- 
tion for  slightly  wounded  if  such  exists.  After  en- 
gagement, he  will  complete  the  evacuation  of  the 
wounded,  assist  in  the  sanitary  police  of  the  field 
and  assist  in  clearing  the  aid  station. 

The  surgeon,  as  soon  as  the  command  is  com- 
mitted to  a  position  or  the  number  of  wounded  war- 
rant such  action,  will,  under  authority  of  the  com- 
manding officer,  choose  a  site  for  the  establishment 
of  the  aid  station.  This  is  usually  established  as 
near  to  the  firing  line  as  the  conditions  of  cover  for 
movement  under  fire  toward  the  front  and  rear,  line 
of  drift  of  the  wounded,  shelter  and  supply  of  wood 
and  water  permit.  Given  cover  accessibility,  and 
proper  lines  of  drift  of  wounded,  under  protec- 
tion from  fire,  the  aid  station  will  be  pushed  as  far 
forward  as  is  possible,  so  long  as  it  will  not,  probably, 
be  involved  in  the  movements  of  the  line.  The  con- 
sideration of  shelter,  wood  and  water  supply  near  at 
hand,  while  desirable,  is  not  absolutely  necessary,  as 
the  first  requirement,  if  in  buildinigs  or  structures 
of  similar  nature,  frequently  draws  hostile  fire,  and 
wood  and  water  can  be  brought  up.  Given  other  con- 
siderations, the  aid  station  should  cover  the  center  in 
order  to  equalize  and  lessen  distances.  The  regiment- 
al aid  station  is  little  more  than  a  geographical  ren- 
dezvous for  wounded,  where  they  can  be  collected  for 
record,  dressed,  possibly  fed,  sorted,  and  sent  to  the 
rear  or  front.  The  knowledge  of  possibility  of  food 
and  care  will  bring  the  wounded  here  and  permit 
organization  of  the  return  of  the  fit,  and  direction  of 
movements  of  ambulants,  and  evacuation  of  trans- 
port cases. 

The  commanding  officer,  combatant  troops,  of 
the  battalion  and  the  sanitary  troops  with  them  will 
be  notified  of  the  site  of  the  aid  station  by  the  com- 


—149— 

manding  officer.  The  surgeon  also  will  notify  the 
battalion  surgeon  of  the  site,  the  battalion  surgeon 
will  notify  the  combatants  and  his  personnel.  Con- 
tact will  be  gotten  with  the  divisional  sanitary  units 
at  as  early  a  time  as  possible,  and  the  dressing  sta- 
tion detachments  and  chief  surgeon  notified  of  site 
and  conditions. 

When  necessity  occurs,  and  not  before,  the 
equipment  will  be  brought  up,  the  packs  unloaded, 
and  the  tent-fly  erected,  if  necessary.  Marks, 
(peeled  twigs,  blazes  or  bandages  on  trees  or  posts) 
will  be  set  up,  showing  direction  to  aid  station: 
larger  marks  are  only  advisable  where  they  cannot 
be  observed  by  the  enemy,  as  they  have  usually 
drawn  fire  both  in  the  Russo-Japanese  and  Euro- 
pean War. 

The  aid  station  is  organized  into  a  receiving, 
dressing,  feeding,  and  dispatching  section.  The 
bearers  of  the  band  are  used  in  evacuating  from  the 
battalions  under  the  band  n.  c.  o's.,  and  noncommis- 
sioned officers  and  privates  of  the  aid  station  party 
are  used  for  technical  work.  All  wounded  passing 
through  the  aid  station  are  recorded  and  those  need- 
ing it  are  tagged.  The  ambulants  are  directed  to 
the  rear  in  parties,  under  charge  of  a  wounded  offi- 
cer or  n.  c.  o.,  the  slightly  wounded  to  the  appropri- 
ate station — and  those  very  lightly  wounded,  who 
do  not  require  movement  to  the  rear,  utilized  or 
returned  to  their  organizations,  usually  escorted 
by  the  band  litter  bearers  (armed).  Here,  as  on 
the  firing  line,  the  least  amount  of  surgical  work 
compatible  with  saving  life  is  done.  The  greatest 
attention  is  paid  to  first  aid,  collection,  sorting,  eva- 
cuation and  organization  of  the  wounded.  Advan- 
tage will  be  taken  of  all  adventitious  materials  or 
aids  in  this  work.  Should  movement  of  the  com- 


—150— 

mand  require  it,  the  station  may  be  reestablished 
where  necessary,  leaving  the  collected  disabled  in 
charge  of  sufficient  personnel  to  care  for  them  until 
taken  over  by  the  organizations  at  the  rear.  The 
personnel  with  a  battalion  not  in  action,  in  reserve, 
will  be  utilized  to  the  utmost  and  all  personnel 
brought  back  as  a  reinforcement,  as  they  clear  their 
front.  The  pack  mule  may  be  sent  to  the  rear  to 
renew  supplies  during  an  action;  and,  after  the 
action,  must  take  on  supplies  to  give  full  comple- 
ment, according  to  the  supply  table. 

On  conclusion  of  the  engagement,  or  during  a 
lull  in  firing,  or  after  nightfall  the  bulk  of  collection 
and  evacuation  will  take  place.  The  extended  range 
and  rapid  fire  action  of  modern  arms  will  ordinarily 
prevent  succor  of  the  wounded  in  the  zone  of  fire, 
and  overshots  the  use  of  wheeled  transport  near  the 
rear  of  the  firing  line.  Here  all  removals  must  be 
made  by  hand  or  litter.  The  regimental  sanitary 
troops,  with  band  auxiliary,  will  make  a  search  of 
their  sections,  collecting  the  wounded,  and  tagging 
the  dead  alike.  If  this  is  at  the  conclusion  of  the 
action,  the  sanitary  troops  will  be  accompanied  by 
combatant  details  which  will  take  over  the  dead,  ex- 
amined and  tagged  and  listed,  by  the  sanitary  per- 
sonnel, for  burial;  and  in  cases  where  necessary, 
assist  the  sanitary  personnel  in  the  collection  of  the 
wounded. 

In  case  the  aid  station  has  cleared  in  its  loca- 
tion at  the  rear,  it  will  be  moved  up  and  reestab- 
lished on  the  field  and  avoid  long  hauls.  When  the 
wounded  are  collected  and  cleared  from  the  aid  sta- 
tions by  the  bearers  or  transport  of  the  ambulance 
company,  a  part  of  the  regimental  personnel  may 
be  withdrawn  to  assist  at  the  dressing  stations  under 
orders  from  the  division  surgeon. 


—151— 

The  final  police  of  the  regimental  section  of  the 
battlefield,  after  removal  of  wounded,  will  proceed 
under  the  advice  of  the  local  medical  officer  in  con- 
nection with  the  supervision  of  the  sanitary  inspec- 
tor of  the  division. 

In  trench  warfare  modern  practice  shows  the 
best  results  where,  like  in  the  planned  defense,  the 
attached  sanitary  troops  are  in  the  trenches  with  the 
combatants  with  the  aid  equipment  and  party  in  a 
special  communicating  trench,  in  such  a  manner  as 
to  permit  access  to  all  parts  of  the  line.  Here  under 
the  protection  of  bomb-proofs  and  trenches,  most 
satisfactory  work  can  be  done  and  the  equipment 
can  be  much  more  elaborate  and  complete.  Evacu- 
ation to  the  rear  is  ordinarily  made  in  this  case  un- 
der cover  of  darkness.  The  possibility  of  good  roads 
under  these  conditions  makes  rapid  evacuation  com- 
paratively easy  and  swift,  and  can  be  direct  from 
the  firing  line  to  a  field,  or  even  an  evacuation  hos- 
pital, or  train  or  boat. 

Artillery  aid  stations  and  those  of  cavalry  dis- 
mounted, conform  to  the  action  of  those  of  infantry, 
except  that  care  must  be  taken  in  the  case  of  the 
aid  station  of  artillery,  to  establish,  rather  on  the 
flank  and  away  from  the  reserve,  as  this  will  or- 
dinarily be  searched  for  in  artillery  combat,  and  the 
wounded  will  be  needlessly  exposed.  The  sanitary 
troops  with  a  cavalry  regiment  will  ordinarily  estab- 
lish little,  and  devote  most  of  their  attention  to  ac- 
companying the  command,  leaving  their  wounded 
with  detached  personnel  to  be  taken  over  by  the  di- 
visional organizations.  As  the  many  small  engage- 
ments of  cavalry  preceding  and  during  general  ac- 
tion will  produce  many  scattered  casualties  over 
a  wide  area,  and  the  aid  party  will  be  of  little  use, 
it  will  usually  be  advisable  to  keep  the  squadron 


—152— 

units  to  full  strength.  Owing  to  the  necessity  of 
frequent  changes  of  position  and  plan  of  action,  the 
regimental  surgeon  serving  with  the  mounted  organ- 
ization as  well  as  those  on  foot,  will  do  well  to  have 
a  mounted  agent  with  the  regimental  headquarters 
when  he  is  absent  at  the  aid  stations  or  elsewhere, 
in  order  to  keep  informed  as  to  the  changes  in  situa- 
tion. 

The  Ambulance  Company 

The  personnel  of  the  ambulance  company  at 
maximum  strength,  consists  of  officers,  5;  enlisted, 
119-150;  ambulances,  12. 

The  ambulance  company  for  duty  assignment 
is  divided  into  four  detachments.  The  bearer  de- 
tachment consisting  of  twyenty  litter  squads,  the 
dressing  station  party,  the  ambulance  detachment, 
and  the  wagon  detachment. 

The  technical  equipment  consists  of  the  personal 
medical  equipment,  the  equipment  in  the  packs,  and 
dressing  station  wagon,  and  the  food  and  dressing 
boxes  of  the  ambulances. 

The  total  of  dressings,  etc.,  for  combat  care  of 
wounded  will  give  dressings  for  approximately  1800 
cases  and  4000  cups  or  dishes  of  restorative  stimu- 
lating food,  such  as  blanc  mange,  beef  tea,  soup, 
milk  punch,  tea,  malted  milk,  oatmeal,  porridge  or 
gruel,  and  chocolate.  That  is  sufficient  for  10%  of 
casualties,  not  considering  the  dressings  put  on  by 
the  attached  units  or  the  equipment  of  the  other  am- 
bulance companies. 

As  given  in  former  lectures  the  ambulance  com- 
panies are  under  the  direct  control  of  the  Director  of 
Ambulance  Companies  and  on  release  of  this  portion 
of  the  sanitary  train  from  the  control  of  the  com- 
mander of  trains,  will  be  managed  by  him  under 


—153— 

orders  of  the  chief  of  staff,  or  surgeon,  during  and 
after  combat.  The  activities  of  the  director  and 
the  ambulance  companies  cover  the  entire  zone,  be- 
tween the  firing  line  to  the  field  hospital.  Under 
the  orders  or  authority  of  the  chief  surgeon,  he  will 
establish  dressing  stations,  change  their  sites  and 
make  proper  arrangements  for  the  collection  and 
transportation  of  the  wounded. 

The  four  detachments  of  the  ambulance  com- 
pany have  usually  different  sections  on  the  field  for 
their  work.  The  bearer  detachments  collect  the 
wounded  from  the  regimental  aid  stations,  or  under 
favorable  conditions  from  the  field,  and  transport 
them  to  the  ambulance  head,  if  conditions  of  terrain 
or  action  permit  use  of  wheeled  transportation  in 
advance  of  the  site  of  the  dressing  station.  The 
dressing  station  party  remains  with  the  dressing 
station  at  its  site  and  is  reinforced  as  may  be  neces- 
sary from  the  personnel  of  the  bearer  section. 

The  ambulance  detachment  transports  the 
wounded  from  as  far  forward  toward  the  actual 
field,  as  is  possible,  terrain  and  fire  considered,  to 
the  dressing  station  or  field  hospital.  The  wagon 
detachment  detaches  one  wagon  with  the  equipment 
and  supply  reserve  of  the  dressing  station  and  sends 
it  as  far  forward  toward  the  dressing  station  as  con- 
ditions permit.  The  other  field  wagons  ordinarily 
remain  back  near  the  divisional  field  trains  when  the 
other  detachments  go  forward. 

The  time  and  place  of  establishment  of  the 
dressing  station  will  be  determined  by  the  conditions 
of  the  action  and  the  terrain ;  for  a  planned  defense, 
they  may  be  established  early  and  the  sites  stated  in 
the  combat  order;  but  for  offensive,  or  rencontre 
actions,  establishment  will  not  be  done  until  the 
positions  of  the  troops,  the  drift  of  the  wounded 


—154— 

and  the  type  of  action  determines  the  necessity.  Too 
early  establishment  will,  in  case  of  an  advance,  leave 
the  station  without  function,  and  require  advance 
and  reestablishment,  or  involve  it  in  the  line  of  fire 
or  movement  of  troops,  in  case  of  rectification  of 
lines. 

The  regimental  sanitary  personnel  will  be  able 
to  handle  the  situation  at  the  front  for  a  considera- 
ble time  and  the  wounded  who  come  back  early  will 
ordinarily  be  ambulants,  who  have  no  need  of  the 
dressing  station.  The  transport  cases  will  hardly  be 
back  to  the  aid  station  during  the  first  hour  of  the 
engagement.  Should  the  lines  advance  materially, 
it  will  be  well  to  advance  the  station  to  the  wounded 
and  avoid  littering  the  patients  any  farther  than 
necessary. 

Littering,  at  best,  is  slow  and  exhausting  work, 
and  every  effort  must  be  made  to  abridge  distance. 
In  the  eariler  part  of  the  Russo-Japanese  War,  much 
difficulty  of  transport  arose,  through  the  tendency 
to  too  early  establishment.  In  delaying  actions  with 
a  planned  defense  and  subsequent  retreats,  early 
establishment  and  evacuation  is  necessary  and  re- 
inforcement of  the  sanitary  personnel  is  desirable 
and  necessary,  particularly  with  bearer  and  ambu- 
lance detachments.  Ordinarily  the  time  for  estab- 
lishment will  come  when  the  advance  has  ceased, 
and  the  regimental  aid  stations  have  more  wounded 
than  they  can  care  for. 

The  division  surgeon  will  determine  where  and 
how  many  stations  will  be  opened  and  will  consider 
in  this  decision  the  field  of  greatest  casualties  and 
probability  of  further  action  as  to  location  and  num- 
ber establishing:  he  may  have  them  establish  in- 
dividually or  combine  and,  if  not  pressed,  will  hold 
one  or  more  in  reserve  to  reinforce  other  stations, 


—155— 

or  to  place  in  points  of  future  casualty,  when  the 
proper  time  arrives. 

The  factors  to  be  considered  in  the  selection  of 
a  site  for  the  dressing  station,  given  necessity  and 
consistency  as  to  battle  plan  and  actions,  are : — 

1.  Location  near  a  practicable  route  of  evacua- 
tion from  the  front  to  the  rear,  usually  on  some 
well  maVked  line  of  approach. 

2.  Possibility  of  cover  at  site  of  station  from 
aimed  and  overshot  fire. 

3.  Sufficient  proximity  to  aid  stations  to  de- 
crease transport  distance,  and,  yet,  not  to  include 
station  in  minor  changes  in  lines. 

4.  Proximity  to  shelter,  wood,  water;  buildings 
as  shelter  have  the  disadvantage  of  attracting  ar- 
tillery fire  and  are  therefore  not  an  unmixed  bless- 
ing, and  wood  and  water  may  be  transported  if  ne- 
cessary;   but    frequently    the    same    inequality    of 
ground  which  affords  cover  and  covered  communica- 
tion to  the  front,  will  give  wood  and  water. 

The  necessity  for  the  establishment,  on  a  prac- 
ticable route  is  obvious  and,  other  things  being 
equal,  should  contemplate  a  point  which  will  inter- 
sect a  line  of  probable  drift  of  wounded,  who  will,  if 
fire  and  cover  permit,  usually,  follow  the  line  by 
which  they  approach  the  field — the  only  route  known 
to  them — and  will  ordinarily  follow  ravines  or  the 
lower  slopes  of  hills,  in  order  to  get  advantage  of  the 
cover  afforded.  Interception  of  these  ambulants  is 
necessary  in  order  to  give  them  proper  direction  and 
care,  at  a  time  when  the  station  is  relatively  idle  as 
they  usually  precede  transport  cases,  and  can  be 
pushed  back  to  the  station  for  slightly  wounded  on 
foot,  or  to  the  field  hospital,  as  their  condition  re- 
quires. 


—156— 

Necessity  requires  that  the  dressing  station  be 
as  close  up  as  possible:  a  distance  beyond  infantry 
or  artillery  fire  would  render  the  establishment  use- 
less. 

Examination  of  almost  any  field  will  show  suffi- 
cient cover  to  permit  movement  forward  of  the  per- 
sonnel and  equipment  with  pack  transportation, 
which  may  subsenquently  be  sent  back  for  supplies. 

On  establishment,  the  bearer  section  will  be 
sent  forward  to  establish  contact  with  the  aid  sta- 
tions, ordinarily  dividing  into  two  sections  of  ten 
litters  each,  with  a  definite  sector  assigned,  by  sub- 
division of  the  ambulance  company  sector  assigned 
by  the  director. 

The  bearer  sections  will  place  Red  Cross  guidons, 
bandages,  or  peeled  twigs,  as  route  markers,  indi- 
cating the  direction  of  the  dressing  station,  while 
moving  forward  and  will  notify  all  regimental  per- 
sonnel of  its  location.  The  commanding  officer  will 
report  time  and  place  of  establishment  to  the  di- 
rector. 

The  dressing  station  will  estabish  the  following 
departments:  Receiving,  dispatching,  slightly  and 
seriously  wounded,  dressing  and  dispensing,  feeding 
and  morgue.  All  patients  received  will  be  examined, 
listed,  tagged,  if  necessary  sorted,  distributed  or 
dressed,  fed  and  dispatched  to  the  rear  or  front. 
The  slighly  wounded,  requiring  evacuation,  will  be 
arranged  in  squads,  in  charge  of  a  wounded  officer 
or  n.  c.  o.,  and,  after  feeding,  marched  to  the  station 
for  slightly  wounded;  those  requiring  movement  to 
the  front  turned  over  to  a  provost  officer. 

The  ambulant,  seriously  wounded,  will  be  sent 
to  the  field  hospital  on  foot,  convoyed  by  ambulances 
loaded  with  transport  cases ;  and  the  transport  cases 
after  being  grouped  as  sitting  and  recumbents, 
loaded  as  such  by  the  dispatching  section. 


—157— 

No  operations  other  than  those  immediately  ne- 
cessary to  save  life  will  be  done,  such  as  tying  or 
clamping  an  artery,  or  opening  the  trachea;  and 
such  operations  .will  be  rare.  Feeding  will  be  limited 
to  stimulating  and  restorative  food  and  drinks,  and 
has  been  found  advantageous,  not  only  from  a  stand- 
point of  pure  medicine,  but  also  as  a  means  of  secur- 
ing attendance  of  the  slightly  wounded,  who  other- 
wise may  straggle  without  control.  Possibility  of 
food  and  aid  brought  many  to  the  dressing  stations 
in  the  Balkan  and  Manchurian  Wars. 

For  purpose  of  bringing  up  reserve  supplies  and 
collecting  local  comforts,  such  as  straw,  hay,  etc., 
the  reserve  wagon  will  be  brought  up  if  possible 
and  the  ambulance  detachment  will  establish  a  head 
at,  or  to  the  front  of  the  dressing  station,  where 
roads  and  cover  permits,  in  order  to  decrease  litter 
haulage. 

Every  effort  should  be  made  to  prevent  over- 
crowding of  dressing  stations,  and  to  facilitate  eva- 
cuation. Additional  transportation,  field  wagons 
and  local  transport,  may  be  used. 

Neither  the  dressing  station  nor  the  ambulance 
detachment  must  be  held  back  on  account  of  casual 
fire,  but  must  advance  from  cover  to  cover  until  it 
reaches  a  relatively  protected  zone.  Movement  in 
column  will  frequently  draw  fire,  as  at  600  yards, 
with  present  system  of  marking,  an  ambulance  can- 
not be  differentiated  from  a  field  wagon,  so  that 
movements  in  evacuation  can  be  frequently  best  ac- 
complished by  single  wagons.  The  capacity  of  a 
dressing  station  in  material  has  been  given,  1500  to 
2000  cases,  the  capacity  of  the  personnel  is  given  as 
from  15  to  20  dressings,  per  surgeon,  per  hour,  in 
fair  weather.  Although  the  Japanese  state  that  at 
Mukden,  two  surgeons  and  two  assistants  placed  25 


—158— 

to  30  dressings  per  hour  and  could  have  done  30  to 
40  in  the  same  time,  in  summer.  Fischer  quotes 
Schaefer  as  saying  that  it  was  not  unusual  for  a 
surgeon  to  do  24  dressings  in  an  hour. 

With  two  medical  officers,  this  would  give  from 
30  to  40,  per  hour,  a  considerable  number  of  wound- 
ed, more  than  half,  will  be  properly  tagged  and 
dressed,  and  these  will  not  need  dressing,  giving  a 
capacity  of  60-80  per  hour  to  the  dressing  station 
unreinforced.  If  additional  help  is  necessary  in  the 
early  stages  of  the  action,  it  must  come  from  the 
medical  officers  of  the  bearer  detachment,  who  can 
double  the  capacity  of  the  dressings ;  and  if  more  is 
needed,  such  can  come  from  the  personnel  of  the 
field  hospitals  if  they  do  not  go  into  action,  and,  after 
the  aid  stations  are  cleared  can  come  from  them: 
and  the  chief  surgeon  may  direct  such  reinforce- 
ment. 

After  fire  has  ceased  and  the  stations  cleared, 
the  bearer  detachment  must  search  for  the  wounded. 
With  the  combatant  forces  in  position,  this  cannot 
be  done  until  after  nightfall  and  then  under  diffi- 
culties. The  Manchurian  War  showed  that  moon- 
light permitted  view  of  the  searchers,  and  on  dark 
nights,  artificial  light  drew  fire.  While  on  the  west- 
ern front  in  the  pan  European  War,  the  close  prox- 
imity of  the  lines,  renders  this  almost  impossible,  so 
much  so  that  many  wounded  have  lain  for  days  with- 
out succor.  Systematic  search  will  be  made  where 
possible,  by  assignment  of  sectors,  and  the  wounded 
will  be*  evacuated  to  the  ambulances,  which  can 
usually  be  brought  up  under  the  conditions  that 
render  this  collection  possible. 

After  clearing  the  wounded  to  the  field  hospitals, 
the  director  of  ambulance  companies  will  usually 
receive  orders  to  pack.  If  help  is  needed  at  the  field 


—159— 

hospitals,  personnel  will  be  assigned  from  the  ambu- 
lance companies  for  this  purpose ;  and  the  ambulance 
companies  will  bivouac  on  the  field  with  the  com- 
mand or  camp  with  the  field  hospitals,  as  directed. 

The  work  of  these  organizations,  both  for  men 
and  animals  is  exceedingly  arduous  and  without  re- 
gard to  hours.  Under  conditions  of  combat  and 
after,  little  rest  can  be  given.  Great  care  must  be 
taken  to  secure  the  most  economical  use  of  these 
organizations,  in  order  to  prevent  exhaustion. 


Lecture     VII 


SANITARY  SERVICE  IN  COMBAT 

Station  for  Slightly  Wounded— Field  Hospital  Com- 
panies, Advance  Group,  Line  or  Communications 
The  Station  for  Slightly  Wounded 

THIS  is  an  establishment  of  our  sanitary  service 
created  as  a  result  of  experience  gained  in  the 
Civil  War  and  emphasized  by  observations  during 
the  Russo-Japanese  War.  It  has  been  adopted  by 
the  Austrians,  British,  and  Germans,  following  our 
example. 

This  station  is  established  for  the  purpose  of 
diverting  the  ambulant  slightly  wounded  from  the 
field  hospitals,  and  evacuation  hospitals.  If  they 
have  been  given  a  definitive  dressing  by  the  regi- 
ment personnel  these  wounded  can  be  sent  directly  to 
the  slightly  wounded  station,  without  interfering 
with  or  encumbering  the  service  of  the  dressing 
stations  and  field  hospitals. 

The  cases  sent  to  these  stations  are  the  slightly 
wounded  ambulant  cases,  who  are  capable  of  march- 
ing back  to  the  railhead  or  if  necessary  to  the  con- 
valescent camps  or  establishments  for  slightly 
wounded  in  the  advance  group  of  the  L  of  C,  on 
their  own  feet.  Such  cases  comprise  wounds  of  the 
upper  extremities,  superficial  wounds  of  the  trunk, 
head,  etc.,  which  will  prevent  full  participation  in 
active  service,  but  will,  ordinarily,  be  able  to  care  for 
themselves  and  result  in  early  return  to  their  organi- 
zations. This  class  of  cases  would  fill  the  space  re- 
161 


—162— 

quired  for  care  of  the  more  seriously  wounded  and 
add  to  the  burden  of  the  transportation,  if  cared  for 
by  the  other  institutions,  and  straggle,  and  be  lost 
from  control,  and  materially  delay  their  recovery 
and  restitution  to  their  organization,  if  turned  loose 
to  make  their  way  to  the  rear  uncontrolled.  Genu- 
ine slightly  wounded  requiring  control  by  this  sta- 
tion amount  to  some  12%  of  all  casualties,  and  these, 
together  with  a  considerable  number  of  cases  of 
wounds  so  slight  that  they  should  be  returned  to 
their  organizations,  and  malingerers  formed  the 
contingent,  who  during  our  war  of  the  rebellion,  and 
the  Russo-Japanese  War,  particularly  in  the  Russian 
service,  the  bulk  of  the  straggling  wounded  who 
were  annoying;  as  they  were  not  only  disorderly, 
but  caused  material  depletion  of  the  total  of  rifles. 
Such  cases  were  seized  upon  by  enthusiastic  citizens 
in  our  Civil  War,  and  in  the  early  days  in  the  French 
service  of  the  pan-European  War  and  taken,  unre- 
corded, to  the  rear  in  great  number.  They  were 
lost  to  the  services  for  considerable  periods  of  time 
and  contributed  much  to  permanent  absenteeism. 

The  station  for  slightly  wounded  assists  much 
in  the  sorting  process  and  may  catch  a  considerable 
number  of  more  serious  cases,  which  can  be  detained 
and  sent  with  proper  transportation  to  the  field 
hospitals. 

Under  proper  administration  of  the  sanitary 
service  no  .wounded  man  should  be  permitted  to  move 
farther  to  the  rear  than  the  field  hospitals  or  aid 
stations,  when  not  in  custody  of  the  sanitary  service ; 
and  no  wounded  man  should  be  permitted  to  move  in 
the  zone  in  front  of  the  field  hospitals  and  aid  sta- 
tion untagged  or  unattended.  Such  requirement 
will  ensure  control  of  wounded  and  give  the  best  re- 
sults in  economy  of  service.  Malingerers  and  tri- 


—163— 

vial  cases  will  not  find  encouragement  or  license, 
and  will  remain  with  their  organizations. 

The  routine  in  the  past  for  the  battle  maling- 
erer has  been  to  avoid  contact  with  the  regimental 
sanitary  personnel,  by  whom  he  is  generally  known, 
by  skulking,  and  by  attaching  himself  to  some  non- 
sanitary  unit  by  affecting  slight  wounds,  gain  the 
rear.  The  requirement  of  constant  sorting  out  and 
control  will  make  this  relatively  impossible. 

The  personnel  of  the  station  for  slightly  wound- 
ed will  ordinarily  consist  of  a  medical  officer,  a  non- 
commissioned officer,  and  six  or  eight  men  of  the 
sanitary  contingent  and  should  include  a  squad  of 
the  military  police  for  the  control  of  the  trivially 
wounded  and  malingerers,  and  their  restitution  to 
their  organizations. 

The  equipment  of  the  station  for  slightly  wound- 
ed will  ordinarily  consist  of  dressings,  medicines, 
food,  and  cooking  utensils,  in  addition  to  that  of  the 
personnel.  Shelter  will  not,  usually,  be  provided, 
but  advantage  will  be  taken  of  buildings  near  the 
point  for  establishment.  All  that  is  needed  at  this 
point  is  sufficient  personnel  to  record,  examine,  re- 
adjust dressings,  and  provide  stimulants  and  re- 
storative food,  as  the  cases  will  have  been  dressed 
before  arrival.  Some  shelter  should  be  provided 
with  straw  or  improvised  bedding,  as  some  cases  will 
become  exhausted  through  shock  and  loss  of  blood 
or  serious  cases  may  be  picked  up — which  will  re- 
quire subsequent  removal. 

The  personnel  and  material  will  come  f r om  the 
ambulance  company  or  more  commonly  from  the 
field  hospitals  as  these  organizations  will  usually  be 
more  or  less  idle  at  the  time  of  establishment  and 
hardly  greatly  occupied  until  the  necessity  for  the 
unit  has  ceased — when  the  equipment  and  personnel 


—164— 

withdrawn  can  most  readily  join  these  organiza- 
tions, as  the  distance  of  these  organizations  from 
the  front  is  somewhat  similar.  The  camp  infirmary 
equipment  will  be  available. 

The  site  for  the  station  for  slightly  wounded 
should  be  well  to  the  rear  on  the  line  of  drift  of 
wounded,  well  out  of  range  of  direct  fire,  preferably 
at  a  fork  or  convergence  of  roads  from  the  flank 
and  center,  near  some  easily  recognizable  object 
which  can  be  mentioned  as  a  guide  to  its  location. 
For  purpose  of  recognition  of  its  position  this  ob- 
ject as  a  church,  school,  monument,  or  natural  for- 
mation should  be  selected,  where  possible,  from 
those  passed  by  the  command  on  advance  to  the 
front.  A  most  satisfactory  distance  from  the  firing 
line  is  one  of  some  2|  or  3  miles,  with  the  under- 
standing that  the  slightly  wounded  station  should 
be  in  advance  and  well  removed  from  the  site  of  the 
field  hospitals  in  order  to  divert  the  slightly  wounded 
from  them. 

Owing  to  the  fact  that  these  stations  are  to  be 
established  well  to  the  rear  and  their  ephemeral 
nature,  a  site  can  be  chosen  early  and  their  location 
announced  in  the  combat  order.  Ordinarily  only 
one  S.  W.  Station  is  established  for  a  division  and 
none  for  units  of  lesser  size ;  but  where,  natural  or 
artificial  conditions  render  it  likely  that  the  entire 
area  cannot  be  drained  by  one  such  station  more  may 
be  established. 

The  station  consists  of  a  receiving  and  forward- 
ing section,  a  dressing  and  feeding  section.  The 
wounded  are  examined,  listed,  sorted  according  to 
their  condition,  and  tagged  if  necessary,  and  fed; 
some  dressings  may  need  renewal  and  some  ex- 
hausted or  hemorrhage  cases  may  require  rest  or 


—165— 

hospital  treatment.     Of  course  these  will  be  de- 
tained. 

Those  to  be  sent  to  the  L  of  C  will  be  arranged 
in  detachments  of  30  or  40  and  placed  under  charge 
of  slightly  wounded  officers  or  noncommissioned 
officers  who  will  be  given  orders,  where  possible, 
with  a  list  of  men  in  his  charge,  giving  the  route  of 
march.  This  route  should  coincide  with  a  line  of 
evacuation  of  wounded  so  that  these  detachments 
may  be  convoyed  or  supported  by  wheeled  convoys 
of  wounded  in  order  to  give  care  to  the  exhausted. 

The  C.  0.  of  the  S.  W.  detachments  should  be 
directed  to  leave  any  exhausted  cases  under  shelter 
on  the  route  and  notify  the  nearest  sanitary  echelon 
of  their  condition  and  position.  If  the  road  be 
long,  arrangements  will  have  been  made  for  rest  and 
refreshment  stations,  which  will  be  necessary  for 
both  the  S.  W.  and  the  transport  cases. 

Field  Hospital  Companies  belong  to  the  division- 
al sanitary  train. 

The  field  hospital  companies  are  controlled  by  a 
Director  of  Field  Hospitals  whose  duties  correspond 
to  those  of  the  director  of  ambulance  companies  and 
the  field  hospitals,  moved,  established,  and  closed 
by  orders  of  the  chief  of  staff  or  chief  surgeon 
usually  through  the  director,  following  the  methods 
outlined  for  ambuance  companies. 

The  purpose  of  the  field  hospital  is  to  provide 
temporary  shelter  and  care  for  the  seriously  wound- 
ed or  sick  in  camp  and,  during  and  after  combat, 
pending  their  evacuation  to  the  rear.  Their  capa- 
city has  been  changed  from  shelter  (tent)  and  bed- 
ding for  108  to  216  patients,  giving  for  a  division 
864  beds  and  they  carry  technical  equipment  for 
many  more  patients  provided  shelter  and  bedding 
material  can  be  secured  from  local  sources. 


—166— 

The  personnel  consist  of  6  medical  officers,  and 
80  enlisted  men.  Transportation,  7  field  wagons,  or 
11  trucks. 

The  equipment  of  our  field  hospital  differs  from 
that  of  the  European  armies  in  the  fact  that  it 
provides  more,  tentage  and  bedding  equipment,  and 
medical  and  surgical  equipment.  The  European  ar- 
mies depending  upon  adventitious  shelter,  bedding 
and  household  equipment  as  a  whole  or  in  part ;  and 
in  that  part  of  the  functions  of  the  field  hospital  are 
covered  in  the  dressing  stations  of  the  sanitary  com- 
pany or  "ambulance"  and  part  by  the  clearing  or 
evacuation  hospital. 

A  recent  reorganization  of  the  French  service 
found  neesssary  during  the  present  war,  has  recog- 
nized the  necessity  of  this  organization,  which  they 
only  had  as  did  the  English  in  the  shelter  section 
of  the  "field  ambulance"  by  introducing  a  new  unit — 
the  surgical  operating  hospital,  a  motor  transport 
affair  of  one  hundred  bed  capacity,  with  a  special 
motor  operating  room.  One  of  these  to  an  army 
corps.  The  functions  of  this  organization  are 
covered  by  the  equipment  of  our  field  hospitals.  Al- 
though present  practice  and  opinion  in  America  and 
abroad  questions  the  advisability  of  performing  any 
but  the  most  immediate  necessary  operations,  at  a 
point  in  front  of  the  more  or  less  fixed  hospitals; 
because  not  only  must  there  be  little  or  no  pressure 
of  wounded  when  these  are  done,  but  also  cases  of 
this  character  require  post  operative  rest,  which 
cannot  be  secured  in  a  mobile  unit. 

The  field  hospital,  packed,  is  as  mobile  as  its 
method  of  transportation,  field  wagons,  or  motor 
trucks,  permits. 

Not  counting  the  desperately  wounded  who  can- 
not endure  extended  transportation,  and  will  conse- 


—167— 

quently,  not  be  taken  to  the  field  hospitals,  unless 
they  establish  on  the  field,  the  field  hospitals  may  be 
expected  to  care  for  about  60%  of  the  total  casual- 
ties, a  high  percentage  of  which  must  be  bedded 
until  evacuation:  the  bedding  capacity  of  the  field 
hospitals  as  given  above  is  864  patients  and  capable 
of  extension,  depending  on  local  improvised  shelter 
and  bedding,  straw  with  personal  blankets  collected 
on  the  field. 

For  an  infantry  division  this  will  give  a  capa- 
city to  accommodate  a  total  casualty  of  roughly  10%. 
The  average  daily  battle  casualties  as  shown  in  the 
Franco-Prussian  War  was  for  the  Germans  4.7% 
and  in  the  Manchurian  for  the  Russians  1.7%  and 
the  Japanese  2%.  The  high  losses  shown  in  some 
battles  in  Manchuria  of  as  high  as  68%  for  some 
organizations  were  distributed  over  several  days ;  al- 
though one  division  lost  30%  in  a  single  day.  No 
sanitary  service  can  be  equipped  to  handle  such  a 
high  daily  loss  and,  in  view  of  the  average  losses 
given  and  possibility  of  reinforcement  by  organiza- 
tions from  divisions  less  hardly  pressed,  this  capa- 
city of  10%  carries  a  fairly  high  factor  of  safety. 

In  combat,  field  hospitals  will  establish  at  posi- 
tions and  times  selected  by  the  division  commander, 
or  surgeon,  in  the  absence  of  instructions.  In  an 
attack  they  will  not  be  established  until  the  advance 
has  ceased  or  the  numbers  of  wounded  at  the  dress- 
ing stations  justify  such  action.  In  a  planned  de- 
fense they  may  be  established  or  at  least  in  position 
of  readiness  early,  to  establish  when  required.  In  a 
meeting  engagement,  the  field  hospitals  will  be 
halted  off  the  road  until  the  course  of  action  is  de- 
termined. 

In  preparation  for  combat  the  field  hospitals 
will  be  assembled  and,  when  establishment  is  justi- 


—168— 

fied,  one  or  more  will  be  sent  forward  to  cover  the 
lines  of  evacuation  from  the  various  sectors,  those 
remaining  unestablished  to  be  held  in  reserve  and 
fed  in  either  position,  as  a  reinforcement  of  other 
hospitals,  or  independently. 

The  field  hospital  can  be  established  in  about 
one  hour,  and  if  clear,  packed  in  one  and  one  half 
hours;  and,  filled  with  wounded,  will  require  three 
ambulance  companies  for  its  evacuation  and  a  much 
longer  time  to  dispose  of  the  wounded  and  pack. 
Particular  care  must  be  taken  to  avoid  establish- 
ment too  early  or  in  an  unsuitable  position,  because 
for  use  for  the  day  after  establishment,  it  is  prac- 
tically immobile. 

The  site  of  establishment  should  be  some  three 
or  five  miles  to  the  rear ;  protected  as  much  as  pos- 
sible from  directed  artillery  fire;  on  good  roads,  to 
the  front  and  rear;  and  near  the  probable  route  of 
sanitary  evacuation,  which  will  place  it  away  from 
the  route  to  the  front  carrying  ammunition  and  re- 
inforcements. An  ample  supply  of  good  water  is 
necessary,  and  it  should  be  located,  where  possible, 
near  suitable  buildings;  these  can  be  utilized  as 
shelter  in  place  of  or  in  addition  to  the  tentage 
carried;  in  addition  to  shelter,  the  vicinity  should 
also  afford  household  conveniences,  straw  and  wood. 
In  selecting  a  location  for  a  field  hospital,  while  due 
regard  should  be  given  to  the  proximity  of  perma- 
nent objects,  as  a  means  of  locating  it;  nevertheless 
the  buildings,  or  site  occupied  by  it,  should  not  be 
capable  of  being  seen  from  the  front,  owing  to  the 
tendency  of  hostile  artillery  to  fire  on  aggregations 
of  buildings,  men  or  troops.  Experience  in  the  pan- 
European  War  would  lead  to  the  assumption  that 
the  Red  Cross  flag  is  not  easily  recognized,  as  such, 
at  distances  given,  or  that  its  protection  has  been 


—169— 

disregarded.  When  establishing  with  adventitious 
shelter  much  of  the  heavy  equipment  of  the  field  hos- 
pitals, will  not  be  unpacked,  and  the  personnel  will 
be  employed  in  collecting  and  improvising  local 
equipment  and  materials  for  hospital  use. 

The  various  routes  to  the  field  hospitals  will  be 
marked  by  day  and  night,  by  guidons,  signs,  or  lan- 
terns. The  same  care  here  is  not  necessary,  as  in 
the  dressing  stations  to  avoid  attracting  hostile  at- 
tention, by  guide  flags,  as  the  distance  is  too  great 
to  permit  recognition  of  ordinary  sized  flags. 

Given  other  conditions  as  satisfactory,  the  field 
hospitals  will  be  located  so  as  to  cover  the  field  of 
greatest  casualty,  and,  should  the  enemy  retire,  they 
will  be  located  near  the  dressing  stations  or  on  the 
field  itself.  Where  field  hospitals  are  ordered  up  to 
replace  a  dressing  station,  they  will  transfer  the 
equipment,  by  exchange,  and  take  over  the  wounded, 
releasing  this  part  of  the  ambulance  company  for 
further  duty  elsewhere. 

The  positions  of  the  field  hospitals  on  the  march 
with  a  division,  when  hostile  contact  is  expected, 
lend  ease  to  their  establishment,  or  position  in  readi- 
ness, following  deployment  of  the  division.  Their 
position  at  the  rear  of  the  main  body,  places  them 
some  five  miles  to  the  rear  of  the  head  of  the  main 
body,  and  should  this  deploy  on  a  position  taken  up 
by  the  advance  guard  movement  forward  at  ordinary 
gaits,  could  put  the  field  hospitals  near  their  pro- 
bable position  within  an  hour  and  half  after  the 
order  for  deployment  is  given,  rather  too  early  for 
a  position  in  readiness. 

In  order  to  clear  the  road,  however,  and  put 
them  near  where  will  be  their  probable  location, 
plans  of  the  division  commander,  roads  and  terrain, 
and  probable  field  of  casualties  and  fire  considered, 


—170— 

the  field  hospitals  will  be  moved  forward,  or  as- 
sembled at  a  convenient  point  on  a  probable  route  of 
evacuation. 

The  director  will  inform  himself  of  conditions 
of  shelter,  supply,  and  communication  in  the  rear  of 
the  sector  covered  by  the  division,  and,  as  soon  as 
he  receives  information  as  to  the  sites  of  the  field 
hospitals,  will  designate  the  organizations  and  ar- 
range for  use  of  shelter  and  supplies  at  hand.  He 
will  get  in  touch  with  the  Director  of  Ambulance 
Companies  and  arrange  for  co-ordinating  his  service 
with  that  of  the  transport.  The  division  surgeon 
will  be  notified  of  the  time  of  establishment  as  it 
occurs. 

The  field  hospital  will  establish:  A  receiving 
and  forwarding,  slightly  wounded  (sitting),  a  seri- 
ously wounded  (bed),  an  operating,  dispensary,  kit- 
chen, morgue  and  transportation  department. 

The  receiving  and  forwarding  section  will  re- 
cord, sort,  and  assign  patients  on  receipt  and  dis- 
patch through  the  transport  section,  moving  the 
received. patients  to  the  wards  and  operating  section, 
according  to  their  classification,  or  turn  them  over 
to  the  transport  column  for  evacuation.  The  oper- 
ating section  will,  as  stated  before,  avoid  operations, 
which  can  be  delayed  until  more  suitable  environ- 
ments are  available,  and  confine  itself  to  those  im- 
mediately necessary  to  save  life,  or  to  prepare  pa- 
tient for  evacuation.  Patients  will  be  cleared  from 
the  field  hospitals  established,  ordinarily,  by  trans- 
fer to  line  of  communications  columns,  transporting 
them  to  evacuation  hospitals  on  trains  or  water 
transportation  or,  in  default  of  these  lines  of  com- 
munications, to  other  field  hospitals  at  the  rear,  in 
order  to  permit  release  of  mobile  units  to  join  thier 
command.  Transfer  of  the  disabled  is  most  easily 


—171— 

and  satisfactorily  made  by  bringing  up  evacuation 
hospital  personnel  and  equipment  on  wagons  or  mo- 
tors and  exchanging  equipment. 

Under  conditions  where  it  will  be  impossible  to 
evacuate  all  of  the  wounded  in  a  field  hospital  (as 
where  one  is  detailed  to  care  for  desperately  wound- 
ed, in  an  advance  or  immobilized  with  wounded  in 
a  retreat) ,  these  wounded  may  be  left  with  suitable 
personnel  and  equipment  and  the  remainder  move 
out  with  the  train. 

The  personnel  of  the  field  hospital  company  will 
ordinarily  furnish  the  personnel  for  the  station  for 
slightly  wounded,  and  this  will  usually  be  desig- 
nated by  the  director,  from  that  of  a  field  hospital 
which  will  be  placed  nearest  this  organization,  in 
order  to  avoid  unnecessary  movement  of  transporta- 
tion and  personnel  in  establishing  and  closing. 
Prior  to  the  time  when  field  hospitals  establish  or 
in  delaying  engagements,  when  establishment  would 
be  inadvisable,  the  personnel  of  the  field  hospital 
companies  may  be  used  to  advantage  as  bearer  de- 
tachments and  reinforcements  to  the  dressing  sta- 
tion personnel. 

The  entire  sanitary  service  of  the  division  must 
be  under  the  observation  and  control  of  the  division 
surgeon,  either  through  the  chief  of  staff,  or  direct. 
The  service  of  the  regimental  sanitary  troops  will  be 
largely  independent,  under  the  control  of  the  regi- 
mental commander  and  surgeon,  as  to  establishment, 
disestablishment,  and  interior  administration,  but, 
under  the  regulations  a  surgeon  may  be  detached  for 
duty  at  a  dressing  station  and  field  hospitals,  and 
this  will  be  done  by  the  chief  surgeon  when  neces- 
sary, from  those  organizations  least  engaged  with 
casualties. 


—172— 

The  surgeon  will  require  reports  of  the  time 
and  site  of  establishment  and  disestablishment, 
the  number  of  casualties,  etc.,  in  order  that  he  may 
be  able  to  direct  the  sanitary  service  economically 
and  use  the  regimental  and  divisional  sanitary  per- 
sonnel in  the  best  manner,  in  the  service  of  dress- 
ing and  evacuation. 

While  the  station  of  the  division  surgeon  is 
with  the  headquarters  of  the  division,  he  must  ex- 
ercise general  supervision  over  the  entire  field, 
either  by  use  of  his  assistant  and  the  sanitary  in- 
spector, or  by  leaving  one  of  these  in  charge  of  his 
office,  by  direct  examination  of  the  conditions.  The 
duties  of  the  surgeon  lie  in  administration  and  direc- 
tion, and  he  can  best  serve  the  sanitary  service,  by 
exercising  these  functions,  rather  than  by  personal 
care  of  the  wounded.  He  will  co-ordinate  the  work 
of  the  several  lines  of  sanitary  aid,  in  order  to  pro- 
cure rapidity  and  continuity  of  action,  in  care  and 
evacuation  of  the  disabled ;  and,  guided  by  his  infor- 
mation of  the  plan  and  course  of  the  combat,  direct 
the  movement,  establishment,  and  closure,  of  the  or- 
ganizations within  his  department. 

Orders  for  this  purpose  will  be  issued  by  the 
chief  of  staff  upon  recommendation  of  the  division 
surgeon  or  may  be  direct  by  the  surgeon,  when  so 
authorized  by  the  division  commander.  It  would 
seem  that  in  stress  of  a  general  action,  it  would  be 
necessary  for  orders  to  be  issued  frequently,  direct 
by  the  surgeon  to  the  director  of  ambulance  com- 
panies and  field  hospitals, in  order  to  avoid  damag- 
ing delays,  and  it  is  probable  that  the  division  com- 
mander will  issue  general  authority  to  cover  such 
action.  Orders  to  directors  and  unit  commanders 
should  be  so  worded,  as  to  cover  the  general  require- 
ments, leaving,  as  in  orders  for  combatant  command- 


—173— 

ers,  arrangement  of  details  to  the  officer  of  whom 
the  action  is  expected. 

Orders  directing  establishing  or  requiring  move- 
ment to  a  position  in  readiness,  should  carry  the 
phrase  "in  the  vicinity  of"  or  "near  a  certain  point," 
in  order  to  permit  use  of  natural  or  artificial  fea- 
tures of  terrain,  shelter,  cover,  or  supply.  Orders 
to  directors  should  be  sufficiently  broad  to  permit 
adaptation  of  the  units  on  hand  to  the  particular  re- 
quirements. 

Communication  and  interchange  of  information 
will  be  constantly  kept  up  between  the  sanitary 
service  of  the  zone  of  advance,  and  the  line  of  com- 
munication, in  order  that  the  service  of  the  medical 
supply  and  evacuation  may  be  most  efficient.  '  Ar- 
rangement will  be  made  for  movement  of  supplies 
to  the  railhead  or  distributing  point  and  transporta- 
tion to  organization  for  re-equipment  after  combat. 
The  advance  surgeon  will  be  notified  of  the  location 
of  field  hospitals  and  the  distribution  and  classifica- 
tion of  wounded  or  sick  therein,  together  with  con- 
ditions of  roads,  etc.,  in  order  that  they  may  be 
taken  over.  On  the  march  and  in  camps  prepara- 
tory to  evacuation,  rendezvous  points  for  collection 
of  disabled  will  be  arranged  for  between  the  divi- 
sion and  advance  surgeons  and  the  sanitary  service 
line  of  communications  will  be  kept  informed  as  to 
possibility  of  combat,  change  of  route,  presence  of 
epidemics,  etc.,  in  order  that  preparation  can  be 
made  in  advance  for  unusual  conditions. 

The  police  of  the  battlefields,  as  stated  before 
will  be  attended  to  by  the  local  commander  in  his 
sector.  Usually  the  sanitary  inspector  will  be  de- 
tailed to  supervise  the  sanitation  of  the  field  and  will 
be  given  such  sanitary  and  combatant  assistance  by 
local  commanders,  under  orders  from  the  division 


—174— 

commander,  as  may  be  necessary.  Sites  for  inter- 
ment or  cremation  of  men  and  animals,  will  be 
chosen  by  the  sanitary  inspector,  with  due  regard 
to  character  of.  soil,  drainage,  convenience  to  field, 
and  unlikelihood  of  disturbance  by  flood  or  animals. 
Action  will  be  taken  to  procure  medical  officers  and 
chaplains  from  the  troops  of  each  locality  for  exam- 
ination and  record  of  the  dead  and  for  appropriate 
services ;  and  details  of  a  noncommissioned  officer  or 
private  from  each  company  to  assist  in  recognition, 
in  cases  where  the  identification  tag  is  not  found; 
and  burial  details  for  collection  and  transporting 
the  dead  and  preparing  and  conducting  the  work  of 
interment  or  cremation.  All  dead  will  be  recorded 
on  casualty  lists  with  organization  and  cause  of 
death,  and  separate  trenches  prepared  for  the  un- 
known and  the  known  of  our  own  troops,  and  for  the 
enemy's.  Those  of  the  same  organization,  will,  as 
much  as  possible  be  buried  together,  and  those  of  our 
own  troops  will  have  their  tags  buried  with  them,  se- 
cured to  the  neck  by  a  copper  wire  of  generous  size. 
The  tags  of  the  enemy,  or  of  the  cremated  dead, 
will  be  retained.  Careful  note  of  location  and  con- 
tents of  burial  trenches  will  be  made  to  facilitate 
later  removal  and  recognition.  Trenches  will  be 
made  at  least  five  feet  deep,  that  is  bodies  should 
be  covered  by  four  feet  of  earth,  in  order  to  prevent 
escape  of  gases  of  decomposition,  or  exhumation  by 
flood  or  animals. 

All  spare  earth  should  be  used  in  mounding 
trenches,  in  order  to  provide  for  sinking  and  to  give 
additional  covering.  As  a  matter  of  sentiment  and 
comfort  to  relatives,  it  is  well  to  have  chaplains  of 
several  denominations  hold  services  for  the  dead,  so 
that  each  may  have  the  benefit  of  the  particular 
rites  of  his  church. 


—175— 

Given  proper  space  and  soil,  burial,  if  properly 
conducted,  is  not  objectionable.  Ordinarily,  in  dis- 
position of  the  dead,  the  end  to  be  secured  is  destruc- 
tion of  the  putrescible  parts  of  the  body,  in  the  least 
time,  without  real  or  sentimental  offense.  To  secure 
the  most  rapid  decomposition,  all  clothing  covering, 
or  boxing  of  bodies,  should  be  interdicted  and  the 
mass  of  dead  should  be  supported  upon  a  course  of 
open  stone  or  logs  in  the  bottom  of  the  trench,  with 
a  drain  for  fluids  leading  to  a  lower  pit.  The  mass 
should  be  topped  with  a  layer  of  straw  or  branches, 
in  order  to  prevent  too  close  contact  of  the  earth 
which  will  prevent  drainage  and  rapid  disintegra- 
tion, and  lastly  mounding  with  all  earth  removed. 
The  use  of  lime,  or  of  other  disinfectants  on  the 
bodies,  or  in  the  grave,  prevents  rapid  disintegra- 
tion and  defeats  the  purpose  of  interment,  without 
accomplishing  anything  that  cannot  be  done  by  four 
feet  of  earth.  Properly  located  and  drained  trenches 
will  secure  this  and  be  relatively  safe. 

Cremation  is  usually  impracticable  on  account 
of  difficulty  of  procuring  fuel  in  sufficient  quantities, 
as  one  single  body  on  an  open  pyre  will  require  one 
third  of  a  cord  of  wood  and  at  least  five  hours  of 
attention.  While  this  is  an  ideal  method  of  disposi- 
tion of  the  dead,  public  sentiment  is  as  yet  hardly 
sufficiently  educated  to  make  it  justifiable,  when  in- 
terment is  practicable ;  but  where  fuel  is  at  hand  and 
character  of  soil  or  rock  formations  and  lack  of 
space  as  within  a  beleaguered  area  does  not  permit 
interment,  it  is  demanded. 

The  records  of  the  friendly  dead  will  be  data  for 
casualty  reports.  The  tags,  records,  private  papers, 
and  possessions  of  the  hostile  dead  will  be  turned 
over  to  the  provost  marshal,  who  will  send  them  to 
the  War  Department,  for  ultimate  transmittal  to  re- 


—176— 

latives  or  other  parties   in  interest,  in  the  home 
country. 

Service  of  the  Lines  of  Communications 
Before,  During  and  After  Combat 

As  stated  in  former  lectures  the  sanitary  serv- 
ice of  the  lines  of  communications  is  divided  ac- 
cording to  the  general  organization,  into  advance, 
intermediate,  and  base  groups ;  each  with  their  pro- 
per surgeon  and  equipment  of  personnel,  units,  and 
supply, — with  the  advance  and  intermediate  groups 
subordinate  to  the  commander  at  the  base. 

The  functions  of  the  surgeon  of  the  base  group 
are  practically  those  of  a  division  surgeon,  and  he  is 
governed  by  similar  regulations.  He  will  have 
charge  of  the  direction  of  the  transportation,  care, 
distribution,  of  patients,  from  the  time  that  they 
are  turned  over  to  the  lines  of  communications  until 
their  final  disposition;  either  by  transfer  to  the 
service  of  the  interior,  or  return  to  their  organiza- 
tions; and,  for  the  purpose  of  caring  for  them,  he 
will  utilize  all  means  of  transportation,  hospitals, 
and  convalescent  camps  within  his  control  and,  un- 
der authority  of  the  commanding  officer,  lines  of 
communications,  will  create  or  establish  such  other 
organizations  as  may  be  necessary.  He  will  arrange 
for  the  supply  of  sanitary  personnel  for  the  lines 
of  communications  and  to  the  sanitary  troops  of  the 
zone  of  advance,  and  in  order  to  regulate  the  flow 
of  these  personnel  to  the  front,  will  establish  casual 
camps  for  these  troops;  will  establish  and  control 
depots  for  sanitary  supplies,  which  will  be  issued 
to  the  organizations  on  the  lines  of  communications 
and  the  zone  of  the  advance ;  and  will  exercise  sani- 
tary supervision  and  control  over  the  area  of  the 


—177— 

lines  of  communication,  and  the  country  contiguous 
thereto. 

Previous  to  combat,  the  surgeon,  base  group, 
will  be  informed  as  to  the  probability  of  action  and 
will  direct  his  subordinates  to  prepare  all  of  their 
organization  for  additional  service.  All  hospitals 
and  institutions  will  be  resupplied  and  cleared  of 
patients,  and  mobile  and  semi-mobile  units  collected 
at  convenient  points  in  the  advance  or  intermediate 
groups  for  service.  Advance  depots  will  be  supplied 
and  additional  units  organized  as  required. 

On  notification  of  imminence  of  action  the  sur- 
geon advance  groups  wrill  bring  his  evacuation  hos- 
pitals up  to  the  railheads,  and  if  the  probable  seat 
of  action  is  well  removed  from  water  or  railheads, 
will  provide  motor  or  wagon  transport  for  them,  so 
that  they  can  be  advanced  as  necessary.  Hospital 
trains  or  boats  will  be  brought  up  to  the  transporta- 
tion head  and  sections  of  advance  supply  depots 
equipped  with  transportation  for  movement  to  the 
distributing  point.  The  evacuation  ambulance  com- 
pany will  be  reinforced  by  additional  wagon  or 
motor  transport  and  advance  well  toward  the  tail  of 
the  column  in  the  zone  of  the  advance.  Sites  and 
shelter  for  hospitals  and  convalescent  camps  will  be 
selected  and  plans  and  equipment  for  improvisa- 
tion of  trains  and  boats  for  patients  prepared,  in  ac- 
cordance with  local  conditions.  Details  for  embark- 
ation stations  will  brought  up  and  rest  stations, 
personnel,  and  equipment,  reinforced;  and  all  mea- 
sures possible  taken  to  secure  rapid  and  efficient  eva- 
cuation, care  and  distribution,  of  the  disabled. 

The  evacuation  ambulance  companies  of  the 
lines  of  communications,  are  allowed  normally,  on 
the  basis  of  one  to  each  division,  and  carry  the  same 
personnel  and  equipment  and  transportation  as  do 


—178— 

the  ambulance  companies,  less  the  four  pack  mules. 
They  will  be  used  for  road  evacuation  of  the  disabled 
from  the  field  hospitals  to  the  evacuation  hospitals 
or  rail,  or  water  head.  Under  normal  conditions  of 
daily  flow  of  disabled,  and  usual  road  distance,  their 
capacity  is  ample,  but  in  preparation  for  combat 
they  must  be  largely  increased  as  to  transportation 
and  personnel,  by  attachment  of  enlisted  men  and 
wheeled  vehicles,  with  enlisted  or  civilian  drivers. 

These  organizations  under  usual  conditions  of 
weather,  work,  on  more  or  less  satisfactory  roads, 
can  employ  motor  transportation  with  excellent  re- 
sults. On  the  continent,  where  the  roads  are  ad- 
mittedly better  than  in  America,  transport  columns 
are  composed  entirely  of  motor  ambulances,  organ- 
ized in  groups  of  fifty,  divided  into  three  sections. 
The  use  of  such  means  of  transport  has  made  pos- 
sible the  rapid  evacuation  of  the  enormous  number 
of  wounded,  which  would  otherwise  have  encum- 
bered the  mobile  organizations  for  days.  To  man 
this  additional  transportation,  the  bearer  detach- 
ment is  available  either  as  attendants  or  drivers. 
Automboile  transportation  in  this  organization  is 
more  economical  in  personnel,  as  the  chauffeurs 
themselves  can  be  used  as  a  loading  detail  and  at- 
tendants, as  they  have  no  teams  that  require  watch- 
ing when  halted.  The  transport  column,  when  route 
conditions  require  extensive  marches  will  establish 
rest  stations  en  route,  for  the  care,  feeding,  and 
treatment  of  the  wounded  en  route,  detaching  a 
medical  officer  or  a  detail  of  enlisted  men  and  equip- 
ment for  this  purpose. 

The  rest  stations  of  a  line  of  evacuation  is  on 
a  by-road,  and  will  be  established  at  points  at  march 
intervals  or  less  and  will  be  arranged  by  use  of 
buildings  or  other  shelter  for  feeding  and  dressing 


ordinary  cases  in  transport  and  bed  equipment  for 
those  cases  that  become  untransportable.  Arrange- 
ment must  be  made  for  rapid  feeding  at  these  points, 
and  measures  will  ordinarily  be  taken  to  apprise  the 
stations  of  the  time  of  arrival  of  convoys  of  wounded. 
Should  the  route  of  evacuation  be  relatively  extended 
and  permanent,  special  parties  will  be  sent  up  from 
the  sanitary  reserve  of  the  line  of  communications 
to  relieve  the  evacuation  ambulance  company  person- 
nel and  equipment. 

Transport  columns  and  rest  station  parties  of 
volunteer  aid  societies  are  extensively  used  abroad 
for  this  duty,  and  can  be  well  used  in  our  service 
particularly  as  a  second  echelon  on  long  routes  of 
evacuation.  Where  convenient,  those  columns  and 
rest  stations  in  the  advance  section  should  consist 
of  the  military  sanitary  service. 

Embarkation  stations  are  formed  at  the  trans- 
port head,  particularly  at  rail  and  water  heads,  for 
the  reception,  care,  and  loading,  of  the  disabled; 
delivered  by  transport  units,  pending  arrival  of 
other  means  of  transportation:  these  correspond  in 
organization  and  equipment  to  rest  stations,  but 
must  have  greater  bed,  feeding,  and  shelter  facili- 
ties. They  may  be  formed  of  line  of  communica- 
tions reserves  or  from  aid  societies  personnel,  with 
a  military  control.  As  they  are  relatively  stationary 
and  will  have  advantage  of  good  shelter  and  accom- 
modations near  a  fixed  line  of  transportation,  they 
can  be  manned  by  voluntary  aid  personnel  to  advan- 
tage. Their  functions  and  duties  are  obvious. 

Rest  stations  on  railway  and  water  transport 
lines  will  ordinarily  not  be  required  by  hospital 
trains,  as  they  will  be  equipped  with  ordinary  ne- 
cessities for  feeding  and  caring  for  the  sick.  Trains 
and  boats  for  paitents,  however,  will  not  be  provided 


—180— 

with  facilities  for  feeding  the  disabled ;  rest  stations 
must  be  equipped  with  material  and  personnel  for 
this  purpose.  They  will  be  located  on  a  siding  or 
dock,  where  boats  or  trains  can  be  stopped  con- 
veniently, and  will  have  meals  prepared  in  advance, 
through  proper  notification.  In  order  to  expedite 
movement,  action  can  be  taken,  as  in  the  German 
service,  to  load  prepared  meals  and  serving  equip- 
ment on  trains  at  the  rest  stations.  The  serving 
equipment  to  be  brought  back  on  the  next  trip. 

More  elaborate  dressing  and  ward  equipment 
will  be  provided  at  these  points,  than  is  had  at  the 
road  stations.  The  personnel  should  consist  of  2 
medical  officers,  and  some  15  or  20  cooks  or  attend- 
ants, arranged  in  day  and  night  shifts. 

The  evacuation  hospitals  are  allowed  two  to  a 
division;  personnel,  16  medical  officers  and  179  en- 
listed men;  equipment  of  two  field  hospitals  and 
divisible  into  sections.  Evacuation  hospitals  have 
no  transportation  fixed,  but  will  require  some  16 
wagons  or  trucks.  Held  well  up  on  the  lines  of  com- 
munications, they  will  be  available  for  use  at  the 
front  as  soon  as  the  conditions  of  the  combat  are 
determined.  Their  function  is  to  provide  more  elab- 
orate care  for  the  wounded  than  can  be  given  in  the 
field  hospitals,  and  they  will  be  used  primarily  to 
clear  the  field  hospitals,  so  that  they  can  move  for- 
ward with  the  command.  As  they  have  no  trans- 
portation, they  will,  ordinarily,  be  kept  on  a  water 
or  rail  transport  line,  packed  for  rapid  movement. 

In  or  after  combat,  these  organizations  may  be 
established  in  whole  or  part,  or  by  section  at  the 
lines  of  communication  transport  head,  or  near  the 
field,  or  moved  to  the  field  and  take  over  the  wounded 
and  field  hospitals,  by  exchange  of  equipment.  In 
the  movement  to  the  field,  if  no  other  transportation 


—181— 

is  available,  the  evacuation  ambulance  company  may 
be  used  as  transportation. 

The  equipment  of  the  evacuation  hospitals  per- 
mits use  of  tentage  for  shelter,  but  wherever  pos- 
sible, buildings  of  the  locality  will  be  taken.  Here, 
more  elaborate  surgery  can  be  done,  as  these  hospit- 
als may  be  fixed,  if  necessary,  and  reserve  organiza- 
tions sent  up  from  the  base  of  the  general  line  of 
communications.  Here,  the  definite  sorting  of  pa- 
tients will  be  made,  and  distribution  according  to 
probable  length  of  disability  be  accomplished.  The 
slightly  wounded,  sent  to  the  convalescent  camps,  ad- 
vance groups;  those  of  moderate  severity  to  the 
hospitals  of  the  intermediate  and  base  groups,  in- 
fectious cases  diverted  to  special  hospitals,  and 
the  relatively  permanently  disabled  sent  to  the  base, 
en  route  to  the  service  of  the  interior. 


First  Aid  and  Personal  Hygiene 

(Extracts  from  Soldier's   Handbook) 

AS  MOST  of  the  first-aid  work  in  war  under  pres- 
ent conditions  will  be  done  by  the  individual 
soldier  acting  alone  and  not  by  a  squad  of  two  or 
more  men,  it  is  important  that  his  training  should 
be  largely  individual  and  such  as  will  develop  self- 
reliance  and  resourcefulness. 

The  object  of  any  teaching  upon  first  aid,  or 
early  assistance  of  the  injured  or  sick,  is  not  only 
to  enable  one  person  to  help  another  but  in  some 
measure  to  help  himself.  The  purpose  of  these  di- 
rections is  to  show  how  this  may  be  done  by  simple 
means  and  by  simple  methods.  It  is  a  mistake  to 
think  that  you  must  know  many  things  to  be  helpful, 
but  you  must  understand  a  few  things  clearly  in 
order  to  assist  the  patient  in  the  severer  cases  until 
he  can  be  seen  by  the  surgeon  or  those  who  are 
thoroughly  trained.  In  ordinary  cases  what  you  can 
do  may  often  be  all  that  is  necessary. 

These  short  instructions  are  intended  for  appli- 
cation anywhere — at  a  military  post,  in  camp,  or 
under  any  circumstances  of  ordinary  life ;  but  as  the 
wounds  received  in  battle  are  the  most  important 
to  the  soldier,  it  is  the  more  necessary  that  he  should 
know  what  to  expect  there,  and  what  to  do  for  him- 
self and  others.  Most  of  these  wounds  are  made  by 
the  rifle  ball,  fewer  by  shell  or  shrapnel,  while  those 
made  by  the  saber  and  bayonet  come  last  in  fre- 
quency. 

Wounds 

When  a  ball  enters  or  goes  through  the  muscles 
or  soft  parts  of  the  body  alone,  generally  nothing 
need  be  done  except  to  protect  the  wound  or  wounds 
183 


—184— 

with  contents  of  the  first-aid  packet,  used  as  fol- 
lows: 

1.  If  there  is  one  wound,  carefully  remove  the 
paper  from  one  of  the  two  packages  without  unfold- 
ing compress  or  bandage  and  hold  by  grasping  the 
outside  folds  between  the  thumb  and  fingers. 

When  ready  to  dress  wound,  open  compress  by 
pulling  on  the  two  side  folds  of  bandage,  being  care- 
ful not  to  touch  the  inside  of  the  compress  with  the 
fingers  or  anything  else. 

Still  holding  one  roll  of  the  bandage  in  each 
hand,  apply  the  compress  to  the  wound  and  wrap 
the  ends  of  the  bandage  around  the  limb  or  part 
until  near  the  ends,  when  the  ends  may  be  tied 
together  or  fastened  with  safety  pins.  The  second 
compress  and  bandage  may  be  applied  over  the  first 
or  may,  if  the  arm  is  wounded,  be  used  as  a  sling. 

2.  If  there  are  two  wounds  opposite  each  other, 
use  one  compress  opened  out — but  with  the  folded 
bandage  on  the  back — for  one  wound,  and  hold  it 
in  place  by  bandage  of  the  compress  used  to  cover 
the  other  wound. 

3.  If  there  are  two  wounds,  not  opposite  each 
other,  apply  a  compress  to  each. 

4.  If  the  wound  is  too  large  to  be  covered  by 
the  compress,  find  and  break  the  stitch  holding  the 
compress  together,  unfold  it,  and  apply  as  directed 
above. 

Be  careful  not  to  touch  the  wound  with  your 
fingers  nor  handle  it  in  any  way,  for  the  dirt  of 
your  hands  is  harmful,  and  you  must  disturb  a 
wound  as  little  as  possible.  NEVER  WASH  THE 
WOUND  EXCEPT  UNDER  THE  ORDERS  OF  A 
MEDICAL  OFFICER. 

The  bandaging  will  stop  all  ordinary  bleeding. 
Generally  this  is  all  that  is  necessary  for  the  first 


—185— 

treatment,  and  sometimes  it  is  all  that  is  needed 
for  several  days.  The  importance  of  the  care  with 
which  this  first  dressing  is  made  can  not  be  too 
seriously  insisted  upon.  It  is  better  to  leave  a 
wound  undressed  than  to  dress  it  carelessly  or 
ignorantly,  so  that  the  dressing  must  soon  be  re- 
moved. 

Bandages  and  Slings 

In  addition  to  the  slings  made  with  the  bandage, 
two  forms  of  slings  furnished  by  the  ordinary  cloth- 
ing are  shown. 

Bleeding  from  Wounds 

Now  and  then  a  wound  will  bleed  very  freely, 
because  a  large  blood  vessel  has  been  wounded,  and 
you  must  know  how  to  stop  the  bleeding,  or  hemor- 
rhage as  it  is  called.  Remember  that  all  wounds 
bleed  a  little,  but  that  as  a  rule  this  bleeding  will 
stop  in  a  few  minutes  if  the  patient  is  quiet,  and 
that  the  firm  pressure  of  the  pads  and  bandage  will 
keep  it  controlled.  When  bleeding  is  severe  a  feel- 
ing of  faintness  occurs  and  often  the  patient  loses 
consciousness.  This  is  due  to  the  weakening  of  the 
action  of  the  heart,  so  that  a  sufficient  supply  of 
blood  does  not  reach  the  brain,  and  the  bleeding 
usually  stops  when  the  pressure  is  thus  diminished. 
The  patient's  head  should  be  at  once  laid  on  a  level 
with  or  lower  than  the  body,  and  attention  given 
rather  to  stopping  the  bleeding  than  a  reviving  the 
patient,  who  will  usually  soon  recover  consciousness 
if  kept  quiet  with  the  head  lowered  after  the  bleeding 
is  checked.  A  little  stimulant,  but  not  much,  may 
be  given  under  these  circumstances.  Occasionally, 
but  not  often,  something  else  must  be  done. 


—186— 

Looking  upon  the  heart  as  a  pump,  you  will 
understand  that  to  stop  the  current  of  blood  pumped 
through  the  arteries  you  must  press  upon  the  blood 
vessel  between  the  wound  and  the  heart.  This  pres- 
sure stops  the  current  of  blood  in  the  same  way  that 
you  would  stop  the  flow  of  water  in  a  leaky  rubber 
hose  or  tube  by  pressing  upon  it  between  the  leak 
and  the  pump,  or  other  source  of  power.  The  points 
or  places  where  you  can  best  do  this  for  the  different 
parts  of  the  body  are  illustrated  in  the  woodcuts. 
These  points  are  chosen  for  pressure  because  the 
blood  vessels  which  you  wish  to  control  there  lie  over 
a  bone  against  which  effective  pressure  can  be  made. 

Points  of  Compression  with  Thumb 
and  Fingers 

The  temporal  artery  is  reached  by  pressure 
in  front  of  the  ear  just  above  where  the  lower  jaw 
can  be  felt  working  in  its  socket.  A  branch  of  this 
artery  crosses  the  temple  on  a  line  from  the  upper 
border  of  the  ear  to  above  the  eyebrow. 

The  carotid  artery  may  be  compressed  by  pres- 
sing the  thumb  or  fingers  deeply  into  the  neck  in 
front  of  the  strongly  marked  muscle  which  reaches 
from  behind  the  ear  to  the  upper  part  of  the  breast- 
bone. 

In  bleeding  from  wounds  of  the  shoulder  or 
armpit  the  subclavian  artery  may  be  reached  by 
pressing  the  thumb  deeply  into  the  hollow  behind 
the  middle  of  the  collar  bone. 

In  bleeding  from  any  part  of  the  arm  or  hand 
the  brachial  artery  should  be  pressed  outwards 
against  the  bone  just  behind  the  inner  border  of 
the  larger  muscle  of  the  arm. 

In  bleeding  from  the  thigh,  leg,  or  foot,  press 
backward  with  the  thumbs  on  the  femoral  artery 


—187— 

at  the  middle  of  the  fold  of  the  groin  where  the 
artery  passes  over  the  bone  and  can  be  felt  beating. 

There  are  two  other  simple  means  for  helping 
to  stop  bleeding — such  as  elevating  or  holding  an 
arm  or  leg  upright  when  those  parts  are  wounded, 
and  by  applying  cold  to  the  wound ;  but  you  will  find 
the  compress  and  bandage,  or  the  pressure  made  by 
your  fingers,  as  described  to  be  most  useful  in  the 
great  majority  of  cases. 

When,  however,  the  bleeding  continues  after 
you  have  used  these  simpler  means,  which  they  may 
do  after  10  or  15  minutes,  you  will  have  to  use  what 
is  called  a  "tourniquet,"  and  generally  will  be  obliged 
to  improvise  one  out  of  material  at  hand..  The 
principle  of  such  a  tourniquet  is  easily  understood 
— a  pad  or  compress  placed  on  the  line  of  the  artery 
and  a  strap  or  band  to  go  over  the  pad  and  around 
the  limb  so  that,  when  tightened,  it  will  press 
the  pad  down  upon  the  artery  and  interrupt  the 
flow  of  the  blood.  In  the  arm  apply  the  tourniquet 
over  the  point  shown  for  compression  by  the  fingers ; 
in  the  thigh,  4  or  5  inches  below  the  groin,  as  it 
can  not  be  applied  higher  up. 

The  pad  or  compress  may  be  made  of  such  an 
object  as  a  cork,  or  smooth  round  stone  wrapped 
in  some  material,  to  make  it  less  rough ;  the  bandage 
folded,  a  handkerchief  or  a  cravat  being  used  for 
the  strap.  After  tying  the  band  closely  around  the 
limb  any  degree  of  pressure  may  be  made  by  pas- 
sing under  it  a  stick,  bayonet,  or  something  of 
that  kind,  and  twisting  or  turning  it  around  so  that 
the  pad  is  pressed  firmly  in  place.  Turn  the  stick 
slowly  and  stop  at  once  when  the  blood  ceases  to 
flow,  fixing  and  stick  in  place  with  another  bandage. 
Remember  that  you  may  do  harm  in  two  ways  in 
using  this  rough  tourniquet.  First  by  bruising  the 


—188— 

flesh  and  muscles  if  you  use  too  much  force,  and, 
second,  by  keeping  this  pressure  up  too  long  and  thus 
strangling  the  limb.  It  is  a  good  rule  to  relax  or 
ease  up  on  this  or  any  other  tourniquet  at  the 
end  of  an  hour,  and  allow  it  to  remain  loose  but  in 
place,  if  no  bleeding  appears.  By  watching  you  can 
tighten  the  tourniquet  at  any  time  if  necessary. 

Fractures 

The  next  injury  you  must  know  how  to  help  is  a 
broken  bone.  The  lower  extremeties,  thigh  and  leg, 
are  more  frequently  wounded  than  the  upper  arm 
and  forearm ;  and  so  you  will  find  more  fractures  of 
the  thigh  and  leg  bones  than  of  the  arm  and  forearm. 
You  will  usually  know  when  one  of  these  long  bones 
is  broken  by  the  way  the  arm  ,or  leg  is  held,  for 
the  wounded  man  loses  power  of  control  over  the 
limb,  and  it  is  no  longer  firm  and  straight.  What 
you  must  do  is  much  the  same  in  all  cases — straight- 
en the  limb  gently,  pulling  upon  the  end  of  it  firmly, 
and  quietly,  when  this  is  necessary,  and  fix  or  re- 
tain it  in  position  by  such  splints  or  other  material 
as  you  may  have.  This  is  called  "setting"  the  bone. 
If  you  have  none  of  the  splint  material  supplied, 
many  common  materials  will  do  for  immediate  and 
temporary  use — a  shingle  or  piece  of  board,  a  car- 
bine boot,  a  scabbard,  a  tin  gutter  or  rain  spout  cut 
and  fitted  to  the  limb,  a  bunch  of  twigs,  etc.  What- 
ever material  you  chose  must  be  well  padded  upon 
the  side  next  to  the  limb,  and  afterwards  secured 
or  bound  firmly  in  place,  care  being  taken  never  to 
place  the  bandage  over  the  fracture,  but  always 
above  and  below. 

Fracture  of  the  arm :  Apply  two  splints,  one  in 
front,  the  other  behind,  if  the  lower  part  of  the 
bone  is  broken;  or  to  the  inner  and  outer  sides  if 


—189— 

the  fracture  is  in  the  middle  or  upper  part ;  support 
by  sling.  The  inner  splint  should  be  short,  not  more 
than  7  or  8  inches  long. 

Fracture  of  the  forearm:  Place  the  forearm 
across  the  breast,  thumb  up,  and  apply  a  splint  to 
the  outer  surface  extending  to  the  wrist,  and  to  the 
inner  surface  extending  to  the  tips  of  the  fingers; 
support  by  sling. 

Fracture  of  the  thigh:  Apply  a  long  splint, 
reaching  from  the  armpit  to  beyond  the  foot  on  the 
outside,  and  a  short  splint  on  the  inside.  The  mili- 
tary rifle  may  be  used  as  an  outside  splint,  but  its 
application  needs  care.  A  blanket  rolled  into  two 
rolls,  forming  a  trough  for  the  limb,  is  useful. 

The  carbine  boot  may  be  used  to  advantage  in 
splinting  fracture  of  the  thigh  and  leg. 

Fracture  of  the  leg :  Apply  two  splints,  one  on 
the  outside,  the  other  on  the  inside  of  the  limb. 
When  nothing  better  can  be  had,  support  may  be 
given  by  a  roll  of  clothing  and  two  sticks. 

Many  surgeons  think  that  the  method  of  fixing 
the  wounded  leg  to  its  fellow,  and  of  binding  the 
arm  of  the  body,  is  the  best  plan  for  the  field, 
as  the  quickest  and  as  serving  the  immediate  pur- 
pose. 

The  object  of  all  this  is  to  prevent,  as  far  as 
possible,  any  motion  of  the  broken  bone,  and  so 
limit  the  injury  to  the  neighboring  muscles,  and  to 
lessen  the  pain. 

Be  very  careful  always  to  handle  a  broken  limb 
gently.  Do  not  turn  or  twist  it  more  than  is  neces- 
sary to  get  it  straight,  but  secure  it  quickly  and 
firmly  in  one  of  the  ways  shown,  and  so  make  the 
patient  comfortable  for  carriage  to  the  dressing 
station  or  hospital.  Time  is  not  to  be  wasted  in 
complicated  dressings. 


—190— 

Other  Wounds 

There  are,  of  course,  many  wounds  of  the  head, 
face,  and  of  the  body,  but  for  the  most  part  you 
will  have  little  to  do  with  these  except  to  protect 
the  wound  itself  with  the  contents  of  the  first-aid 
packet,  or,  if  bleeding  makes  it  necessary,  use  in 
addition  several  of  the  packet  compresses  to  control 
it.  As  the  surface  blood  vessels  of  the  head  and 
face  lie  over  the  bones  and  close  to  them,  it  will 
generally  not  be  difficult  to  stop  the  bleeding  by 
this  means  or  by  the  pressure  with  the  fingers,  as 
already  shown.  Remember,  as  you  were  told,  to 
make  the  pressure  between  the  heart  and  the  bleed- 
ing point  when  the  blood  flows  in  jets  or  pulsations, 
showing  that  an  artery  is  cut.  When,  however,  the 
blood  flows  in  a  steady  stream  and  is  somewhat  dark 
in  color  the  wound  is  from  a  vein,  and  pressure 
should  be  made  by  a  fairly  tight  dressing  and  band- 
age over  the  bleeding  point,  reenforced,  if  neces- 
sary, by  pressure  with  the  fingers  over  the  band- 
age until  the  bleeding  ceases. 

With  wounds  about  the  body,  the  chest,  and  the 
abdomen  you  must  not  meddle,  except  to  protect 
them,  when  possible  without  much  handling,  with 
the  materials  of  the  packet. 

Cautions 

You  have  already  been  warned  to  be  gentle  in 
the  treatment  of  the  wounded,  and  the  necessity 
for  not  touching  the  wound  must  always  be  in  your 
mind;  but  there  are  some  other  general  directions 
which  you  will  do  well  to  remember. 

1.  Act  quickly,  but  quietly. 

2.  Make  the  patient  sit  down  or  lie  down. 

3.  See  an  injury  clearly  before  treating  it. 


—191— 

4.  Do  not  remove  more  clothing  than  is  neces- 
sary to  examine  the  injury,  and  keep  the  patient 
warm  with  covering  if  needed.     Always  rip,  or,  if 
you  can  not  rip,  cut  the  clothing  from  the  injured 
part,  and  pull  nothing  off. 

5.  Give  alcoholic  stimulants  cautiously  and  slow- 
ly, and  only  when  necessary.    Hot  drinks  will  often 
suffice  when  obtainable. 

6.  Keep  from  the  patient  all  persons  not  ac- 
tally  needed  to  help  him. 

The  Diagnosis  Tag 

The  diagnosis  tag  is  very  important  in  prevent- 
ing unnecessary  handling  of  the  wounded  man  and 
interference  with  his  dressing  on  the  field.  When 
available,  it  is  to  be  attached  by  the  person  who 
applies  the  first  dressing  and  is  not  to  be  removed 
until  the  patient  reaches  the  field  hospital.  When  a 
patient  has  a  tag  on,  it  is  to  be  carefully  read  before 
additional  treatment  is  given,  and  will  usually  indi- 
cate that  no  further  treatment  is  needed  before 
reaching  the  hospital. 

.    Other  Accidents  and  Injuries 

There  are  a  few  other  conditions  about  which 
you  should  be  informed,  although  they  are  not 
peculiar  to  military  life,  the  first  two  only  being 
related  to  wounds. 

Poisoned  Wounds 

When  a  wound  is  known  to  be  poisoned,  such 
as  one  infected  by  the  venom  of  a  snake  or  a  rabid 
animal,  the  treatment  should  be  directed  toward 
preventing  the  passage  of  the  poison  into  the  cir- 
culation. In  snake  bites  the  poison  acts  quickly; 


—192— 

to  prevent  its  absorption  a  bandage  should  be  car- 
ried around  the  limb  between  the  wound  and  the 
heart,  tight  enough  to  compress  the  veins;  then 
get  the  poison  out  of  the  wound  by  laying  it  open 
and  sucking  the  poison  out  (if  there  is  no  crack 
in  the  mouth  or  ips)  and  destroying  what  is  left  by 
cauterization  with  fire  or  caustic.  Stimulants  may 
be  freely  given  if  the  heart  is  weak.  Care  should 
be  taken,  however,  not  to  poison  the  patient  with 
overdoses  of  whisky  or  other  stimulant,  as  has 
been  frequently  done,  especially  in  the  case  of  chil- 
dren. Do  not  give  over  half  a  pint  of  whisky  to  a 
grown  person  inside  of  four  hours,  and  proportion- 
ately less  for  children,  divided  into  four  doses. 

In  the  bite  of  a  rabid  animal  the  poison  is  for 
a  long  time  localized  in  the  wound  and  there  is  no 
danger  of  immediate  absorption.  Do  not  use  a 
tourniquet,  but  use  the  other  local  measures  advised 
for  snake  bite. 

Shock 

By  this  term  is  meant  a  very  severe  physical  and 
mental  depression  following  extensive  wounds,  such 
as  those  produced  by  shell,  and  ordinary  wounds 
in  which  the  chest  and  abdomen  are  entered.  You 
can  hardly  mistake  this  condition,  for  it  resembles 
approaching  death.  If  possible,  the  patient  should 
not  be  moved,  but  kept  still,  lying  down  with  the 
head  low,  warmed,  and  carefully  stimulated.  This 
will  be  difficult,  perhaps  impossible,  on  the  battle 
field,  but  it  should  be  attemped  unless  removal  is 
unavoidable. 

Fainting 

This  condition  is  generally  the  result  of  severe 
bleeding,  or  exhaustion  from  fatigue.  The  patient 


—193— 

should  be  laid  upon  his  back,  head  lowered,  arms  by 
the  side,  feet  extended,  and  should  be  carefully 
stimulated..  This  condition  is  rarely  dangerous. 

Poisoning 

Poisoning  by  way  of  the  stomach  may  result 
from  swallowing  mineral  or  vegetable  poisons.  In 
the  military  service  it  often  follows  the  taking  of 
food  which  has  undergone  changes  resulting  in  the 
production  of  poisons — ptomaines,  etc. 

Whenever  there  is  no  evidence  of  caustic  action, 
such  as  burns  on  the  mouth,  an  effort  should  be  made 
to  empty  the  stomach  and  bowels  by  the  free  use 
of  emetics  and  laxatives,  such  as  mustard  and  warm 
water,  two  teaspoonf uls ;  a  tablespoonful  of  salt  in 
a  glass  of  warm  water;  epsom  or  rochelle  salts; 
castor  oil,  etc.  After  the  poison  has  been  evacuated, 
give  stimulants  and  apply  heat  and  rubbing  extern- 
ally. 

When  the  lips  are  burned,  give  no  emetic ;  give 
olive  oil,  cottonseed  oil,  or  castor  oil,  internally,  and 
also  the  proper  antidote  if  you  know  it. 

Drowning 

Being  under  water  for  four  or  five  minutes  is 
generally  fatal,  but  an  effort  to  revive  the  apparent- 
ly drowned  should  always  be  made  unless  it  is 
known  that  the  body  has  been  under  water  for  a  very 
long  time.  The  attempt  to  revive  the  patient  should 
not  be  delayed  for  the  purpose  of  removing  his 
clothes  or  placing  him  in  the  ambulance.  Begin  the 
procedure  as  soon  as  he  is  out  of  the  water,  on  the 
shore  or  in  the  boat.  The  first  and  most  important 
thing  is  to  start  artificial  respiration  without  delay. 

The  Schaef er  method  is  preferred  because  it  can 
be  carried  out  by  one  person  without  assistance,  and 


—194— 

because  its  procedure  is  not  exhausting  to  the  opera- 
tor, thus  permitting  him,  if  required,  to  continue  it 
for  one  or  two  hours.  Where  it  is  known  that  a 
person  has  been  under  water  for  but  a  few  minutes, 
continue  the  artificial  respiration  for  at  least* one 
and  a  half  to  two  hours  before  considering  the  case 
hopeless.  Once  the  patient  has  begun  to  breathe, 
watch  carefully  to  see  that  he  does  not  stop  again. 
Should  the  breathing  be  very  faint,  or  should  he 
stop  breathing,  assist  him  again  with  artificial  res- 
piration. After  he  starts  breathing  do  not  lift  him, 
nor  permit  him  to  stand  until  the  breathing  has  be- 
come ftill  and  regular. 

As  soon  as  the  patient  is  removed  from  the 
water,  turn  him  face  to  the  ground,  clasp  your 
hands  under  his  waist  and  raise  the  body  so  any 
water  may  drain  out  of  the  air  passages  while  the 
head  remains  low. 

Schaefer  Method 

The  patient  is  laid  on  his  stomach,  arms  ex- 
tended from  his  body  beyond  his  head,  face  turned 
to  one  side  so  that  the  mouth  and  nose  do  not  touch 
the  ground.  This  position  causes  the 'tongue  to  fall 
f orwrard  of  its  own  weight  and  so  prevents  its  falling 
back  into  the  air  passages.  Turning  the  head  to 
one  side  prevents  the  face  coming  into  contact  with 
mud  or  water  during  the  operation.  This  position 
also  facilitates  the  removal  from  the  mouth  of  for- 
eign bodies  such  as  tobacco,  chewing  gum,  false 
teeth,  etc.,  and  favors  the  expulsion  of  mucus,  blood, 
vomitus,  serum,  or  any  liquid  that  may  be  in  the 
aid  passages. 

The  operator  kneels,  straddles  one  or  both  of 
the  patient's  thighs,  and  faces  his  head.  Locating 
the  lowest  rib,  the  operator,  with  his  thumbs  near- 


—195— 

ly  parallel  to  his  fingers,  places  his  spread  hands  so 
that  the  little  finger  curls  over  the  twelfth  rib.  If 
the  hands  are  on  the  pelvic  bones  the  object  of  the 
work  is  defeated ;  hence  the  bones  of  the  pelvis  are 
first  located  in  order  to  avoid  them.  The  hand  must 
be  free  from  the  pelvis  and  resting  on  the  lowest  rib. 
By  operating  on  the  bare  back  it  is  easier  to  locate 
the  lower  ribs  and  avoid  the  pelvis.  The  nearer 
the  ends  of  the  ribs  the  hands  are  placed  without 
sliding  off,  the  better.  The  hands  are  thus  removed 
from  the  spine,  the  fingers  being  nearly  out  of  sight. 

The  fingers  help  some,  but  the  chief  pressure 
is  exerted  by  the  heels  (thenar  and  hypothenar  em- 
inences) of  the  hands,  with  the  weight  coming 
from  the  shoulders.  It  is  a  waste  of  energy  to  bend 
the  arms  at  the  elbows  and  shove  in  from  the  sides, 
because  the  muscles  of  the  back  are  stronger  than 
the  muscles  of  the  arms. 

The  operator's  arms  are  held  straight,  and  his 
weight  is  brought  from  his  shoulders  by  bringing 
his  body  and  shoulders  forward.  This  weight  is 
gradually  increased  until  at  the  end  of  the  three 
seconds  of  vertical  pressure  upon  the  lower  ribs 
of  the  patient  the  force  is  felt  to  be  heavy  enough 
to  compress  the  parts ;  then  the  weight  is  suddenly 
removed;  if  there  is  danger  of  not  returning  the 
hands  to  the  right  position  again  they  can  remain 
lightly  in  place,  but  it  is  us.ually  better  to  remove 
the  hands  entirely.  If  the  operator  is  light,  and  the 
patient  an  over-weight  adult,  he  can  utilize  over  80 
per  cent  of  his  weight  by  raising  his  knees  from  the 
ground,  and  supporting  himself  entirely  on  his  toes 
and  the  heels  of  his  hands,  the  latter  properly  placed 
on  the  ends  of  the  floating  ribs  of  the  patient  In 
this  manner  he  can  work  as  effectively  as  a  heavy 
man. 


—196— 

A  light  feather,  or  a  piece  of  absorbent  cotton 
drawn  out  thin  and  held  near  the  nose  by  some  one, 
will  indicate  by  its  movements  whether  or  not  there 
is  a  current  of  air  going  and  coming  with  each  forced 
expiration  and  spontaneous  inspiration. 

The  natural  rate  of  breathing  is  12  to  15  times 
per  minute.  The  rate  of  operation  should  not  exceed 
this ;  the  lungs  must  be  thoroughly  emptied  by  three 
seconds  of  pressure,  then  refilling  takes  care  of 
itself.  Pressure  and  release  of  pressure,  one  com- 
plete respiration,  occupies  about  five  seconds.  If 
the  operator  is  alone  he  can  be  guided  in  each  act 
by  his  own  deep,  regular  respiration,  or  by  counting, 
or  by  his  watch  lying  by  his  side.  If  comrades  are 
present,  he  can  be  advised  by  them. 

The  duration  of  the  efforts  at  artificial  respira- 
tion should  ordinarily  exceed  an  hour;  indefintely 
longer  if  there  are  any  evidences  of  returning  ani- 
mation, by  way  of  breathing,  speaking,  or  move- 
ments. There  are  liable  to  be  evidences  of  life  within 
25  minutes  in  patients  who  will  recover  from  electric 
shock,  but  where  there  is  doubt,  the  patient  should 
have  the  benefit  of  the  doubt.  In  drowning,  especial- 
ly, recoveries  are  on  record  after  two  hours  or  more 
of  unconsciousness ;  hence,  the  Schaef er  method,  be- 
ing easy  of  operation,  is  more  likely  to  be  persisted 
in. 

Aromatic  spirits  of  ammonia  may  be  poured  on 
a  handkerchief  and  held  continuously  within  3  inches 
of  the  face  and  nose ;  if  other  ammonia  preparations 
are  used,  they  should  be  diluted  or  held  farther  away. 
Try  it  on  your  own  nose  first. 

When  the  operator  is  a  heavy  man  it  is  neces- 
sary to  caution  him  not  to  bring  force  too  violently 
upon  the  ribs,  as  one  of  them  might  be  broken. 


—197— 

Do  not  attempt  to  give  liquids  of  any  kind  to 
the  patient  while  unconscious.  Apply  warm  blankets 
and  hot  water  bottles  as  soon  as  they  can  be  obtained. 

The  Schaefer  method  of  artificial  respiration  is 
also  applicable  in  cases  of  electric  shock,  asphyxia- 
tion by  gas,  and  of  failure  or  respiration  following 
concussion  of  the  brain. 

First-Aid  Rules 

1.  Never  touch  a  wound  with  anything  unclean 
— dirty    fingers,    nondisinfected    bandages,    dirty 
water,  etc.;  it  may  cause  inflammation,  ulceration, 
or  blood  poisoning. 

2.  Expose  the  wound  by  removing  the  covering 
article  of  dress,  which  contains  many  impurities.  Un- 
button or  cut  clothes  and  examine  extent  of  bleeding. 
Open  all  articles  of  clothing  which  might  hinder 
circulation  of  blood  or  breathing   (collar,  necktie, 
belt) .    To  avoid  pain  and  bleeding,  raise  legs  by  put- 
ting under  them  a  blanket  roll,   saddle,  truss  of 
straw,  etc.;  slight  bleeding  will  often  cease  in  this 
position  of  its  own  accord,  without  bandaging.     A 
bandage  is  advisable  to  protect  the  wound  from  dirt, 
flies,  or  cold.     Use  the  first-aid  packet.      (Coats, 
pouches,  haversacks,  etc.,  may  be  used  as  pillows. 

3.  If  the  wound  does  not  bleed  at  all  or  only 
a  few  drops  at  a  time,  no  constriction  or  pressure 
is  necessary. 

4.  If  the  blood  is  spurting  in  a  strong  stream 
from  a  wound,  you  must  use  measures  to  stop  it. 

5.  Whoever  is  able  to  walk  after  being  wounded 
must  repair  at  once  to  the  dressing  station.    Those 
who  can  not  walk  must  be  carried  by  stretcher  bear- 
ers and  must  await  their  arrival  by  lying  down  as 
quietly  and  as  comfortably  as  possible  in  order  to 
avoid  pain,  bleeding,  and  aggravation  of  the  wound. 


—198— 
Sunstroke 

Sunstroke  or  heat  stroke  occurs  in  persons  ex- 
posed to  high  temperature  either  in  or  out  of  the 
sun.  The  face  is  flushed,  skin  hot  and  dry,  breathing 
labored,  pulse  rapid,  heat  of  body  great.  The  patient 
may  be  unconscious.  Place  him  in  the  shade,  remove 
outer  clothing,  wet  the  undershirt,  and  try  to  lessen 
heat  of  body  by  cold  applications  to  the  head  and 
surface  generally.  Give  water  to  patient  to  drink 
as  soon  as  he  is  able  to  swallow. 

The  heat  may  also  cause,  especially  when  soldier 
is  much  fatigued,  a  form  of  exhaustion  without  in- 
sensibility. Rest  on  the  back  in  the  shade  with  cold 
applications  to  the  head  and  a  little  aromatic  spirits 
of  ammonia  are  usually  sufficient  to  relieve. 

In  rare  cases  this  exhaustion  may  go  on  to 
threatened  collapse,  with  cold  skin  and  extremities, 
pale  face,  and  very  weak  pulse.  Here  alcoholic  stim- 
ulants and  heat  to  the  body  become  necessary. 

It  is  well  to  be  warned  that  both  sunstroke  and 
heat  exhaustion  are  common  and  severe  among 
drinkers  and  the  intemperate. 

Burns 

Do  not  pull  the  clothing  from  the  burnt  part, 
but  rip  or  cut  it  off.  Do  not  break  the  blisters,  or 
prick  them  even  if  large.  Protect  a  burn  quickly 
with  a  mixture  of  equal  parts  of  linseed  or  olive  oil 
and  limewater,  if  you  have  them ;  or  with  the  plain 
oil,  covering  the  whole  with  lint  or  cotton  wool.  Put 
nothing  on  a  burn  that  will  be  difficult  to  remove 
afterwards. 

Freezing  and  Frostbite 

The  part  frozen,  which  looks  white,  or  bluish 
white,  and  is  cold,  should  be  very  slowly  raised  in 


—199— 

temperature  by  brisk  but  careful  rubbing,  in  a 
cool  place  and  never  near  a  fire.  Stimulants  are  to 
be  given  cautiously  when  the  patient  can  swallow, 
and  followed  by  small  amounts  of  warm  liquid  nour- 
ishment. The  object  is  to  restore  the  circulation 
of  the  blood  and  the  natural  warmth  gradually  and 
not  violently.  Care  and  patience  are  necessary  to 
do  this. 


Transportation 

The  carriage  of  patients,  for  moderate  distances 
on  or  from  the  field,  is  best  done  with  the  service 
litter,  and  when  that  can  not  be  procured,  by  some 
improvised  substitute  which  secures  the  comfort  and 
safety  of  the  person  disabled.  These  methods,  and 
those  by  one  or  more  bearers,  are  fully  described 
in  the  Drill  Regulations  for  the  Hospitals  Corps,  and 
are  not  repeated  here. 

It  will  generally  be  found  necessary  during  or 
after  an  action  to  restrict  the  number  of  bearers  to 
two,  and  attention  to  methods  requiring  not  more 
than  two  bearers  is  recommended. 


Take  care  of  Your  Health 

1.  In  times  of  peace  and  freedom  from  deadly 
infectious  diseases  about  4  men  out  of  every  regi- 
ment of  1,000  men  die  of  disease  in  a  year.  In  time 
of  war  this  number  is  greatly  increased  on  account 
of  unavoidable  exposures  and  privations.  A  little 
knowledge  and  a  little  care  on  the  part  of  each 
soldier  will  often  prevent  him  from  becoming  sick, 
and  will  increase  the  efficiency  of  the  command  to 
which  he  belongs.  Knowledge  alone  is  of  no  use 
unless  care  is  taken  to  apply  it  practically. 


—200— 

2.  A  soldier  should  care  for  his  teeth  because 
their  damage  or  loss  will  result  in  improper  chewing 
of  food  and  thus  in  various  diseases  of  the  digestive 
system.    Decay,  which  is  the  commonest  disease  of 
the  teeth,  is  caused  by  allowing  particles  of  food 
to  remain  on  and  between  them.     These  should  be 
removed  by  thorough  brushing.     It  is  well  to  use 
a  good  tooth  powder  once  or  twice  daily,    In  order 
that  decay  of  the  teeth  may  be  detected  before 
serious    damage    has    occurred,    a    dental    surgeon 
should  be  consulted  at  frequent  intervals.    Toothache 
indicates  that  the  deeper  parts  of  the  teeth  have 
become  diseased  and  a  soldier  should  not,  therefore, 
wait  until  the  teeth  ache  to  consult  a  dentist,  as  by 
that  time  destruction  may  be  so  great  as  to  much 
increase  the  severity  of  the  dental  operations  needed 
or  even  to  make  impossible  any  effective  repair. 

3.  A  soldier  should  endeavor  to  be  always  at 
his  best.    He  should  avoid  all  exposures,  not  in  line 
of  duty,  which  he  knows  would  be  likely  to  injure 
his  health,  for  if  he  is  from  any  cause  below  par 
he  is  liable  to  break  down  under  influences  which 
otherwise  might  have  had  but  little  effect  on  him. 

4.  Even  in  garrison,  in  time  of  peace,  soldiers 
often  expose  themselves  unnecessarily  by  going  out 
without  overcoats  when  the  weather  is  such  as  to 
require  their  use,  or  by  failing  to  remove  damp  socks 
or  other  clothing  on  their  return  to  barracks. 

5.  Before  starting  on  a  campaign  the  soldier 
should  provide  himself  with  the  necessaries  for  per- 
sonal cleanliness  and  for  keeping  his  clothing  in 
repair;  towel,  soap,  toothbrush,  a  few  strong  safety 
pins,  and  spare  buttons.    His  shoes  and  socks  should 
be  carefully  selected  to  fit,  and  it  is  well  to  have 
shoes  broken  in  by  a  few  days'  usage  before  starting. 

6.  At  rests  on  the  march  he  should  sit  down  or 


—201— 

lie  down  if  the  ground  is  suitable,  for  every  minute 
so  spent  refreshes  more  than  five  minutes  standing 
or  loitering  about. 

7.  At  the  midday  rest  lunch  should  be  eaten, 
but  it  should  always  be  a  light  meal. 

8.  On  the  march  or  during  exercise    in    hot 
weather  the  body  loses  water  continuously  by  the 
skin  and  lungs,  and  this  loss  must  be  replaced  as  it 
occurs  to  keep  the  blood  in  proper  condition.     Free 
evaporation  of  water  from  the  skin  is  necessary  to 
keep  the  body  at  its  natural  temperature  and  prevent 
heat  prostration.     Therefore,  not  only  must  water 
be  supplied  as  needed,  but  the  clothing  should  be 
open,  when  permitted,  to  assist   the   evaporation. 
Only  a  few*  swallows  should  be  taken  at  a  time,  no 
matter  how  plentiful  the  water  supply  may  be.  When 
exceeding  thirsty,  after  a  long  stretch,  water  should 
not  be  taken  freely  at  once  but  in  smaller  drinks  at 
intervals,  until  the  desire  for  more  is  removed.  Very 
little  water  should  be  taken  during  the  first  two 
hours  of  the  march,  but  after  the  seventh  mile  in 
hot,  oppressive  weather  a  canteenful  will  be  needed 
for  each  6  or  7  miles  march.     If  the  soldier  starts 
with  a  full  canteen  it  should  last  him,  therefore, 
for  an  ordinary  march  of  14  miles. 

9.  Smoking  in  the  heat  of  the  day  or  on  the 
march  is  depressing  and  increases  thirst. 

10.  On  hot  marches  water  should  be  taken  quite 
frequently,  but,  as  already  stated,  in  small  quantities 
at  a  time,  to  replace  the  loss  by  perspiration.    This 
will  often  prevent  attacks  of  heat  exhaustion  and 
sunstroke. 

11.  On  a  hurried  or  forced  march,  particularly 
in  sultry  weather,  a  soldier  may  become  faint  and 
giddy  from  the  heat  and  fatigue.    His  face  becomes 
pale,   his   lips   lead-colored,  his   skin   covered  with 


— 202 — 

clammy  perspiration,  and  he  trembles  all  over.  His 
arms  and  equipments  should  be  removed  and  his 
clothing  opened  at  the  neck,  while  he  is  helped  to 
the  nearest  shade  to  lie  down,  with  his  head  low, 
until  the  ambulance  train  or  wagons  come  up.  Mean- 
while, fan  him,  moisten  his  forehead  and  face  with 
water,  and,  if  conscious,  make  him  swallow  a  few 
sips  from  time  to  time. 

12.  In  sunstroke  the  man  is  unconscious  and 
often  has  convulsions.     He  should  be  cared  for  as 
stated  in  paragraph  11,  using  cold  water  freely  on 
the  head,  face,  and  body,  until  the  arrival  of  the 
surgeon. 

13.  Military  operations  often  have  to  be  con- 
ducted without  regard  to  temperature,* but  in  hot 
weather  unnecessary  exposure  to  the  sun  should  be 
avoided. 

14.  When  camp  is  reached  and  the  tents  pitched, 
each  tent  should  be  trenched  to  keep  out  the  rain- 
fall, even  although  rain  seems  unlikely.    Each  man 
should  then  prepare  the  floor  for  his  bed  by  picking 
out  hard  irregularities  and  scooping  out  a  shallow 
depression  for  the  hip  bones.     Grass,  hay,  leaves, 
or  other  available  material  should  be  laid  on  as  a 
mattress,  with  the  rubber  poncho  or  slicker  over  all 
to  keep  dampness  from  the  body.    In  good  weather 
blankets  should  be  unrolled  and  spread  out  to  air 
before  the  time  for  their  use. 

15.  If  the  soldier  comes  into  camp  much  ex- 
hausted a  cup  of  hot  coffee  is  the  best  restorative. 
When  greatly  fatigued  it  is  dangerous  to  eat  heartily. 

16.  When  the  tents  have  been  arranged  for  the 
night  and  the  duties  of  the  day  are  practically  over, 
the  soldier  should  clean  himself  and  his  clothes  as 
thoroughly  as  the  means  at  hand  will  permit.    No  op- 
portunity of  taking  a  bath  or  of  washing  socks  and 


—203— 

underclothing  should  be  lost.  In  any  event  the  feet 
should  be  bathed  or  mopped  with  a  wet  towel  every 
evening  to  invigorate  the  skin. 

17.  In  the  continued  absence  of  opportunity  for 
bathing  it  is  well  to  take  an  air  bath  and  a  moist 
or  dry  rub  before  getting  into  fresh  underclothes 
and,  in  this  case,  the  soiled  clothes  should  be  freely 
exposed  to  the  sun  and  air  when  the  blanket  roll 
is  unpacked. 

18.  By  attention  to  cleanliness  of  the  person  and 
of  the  clothing  the  discomforts  of  prickly  heat,  chaf- 
ing, cracking,  blistering,  and  other  irritations   of 
the  skin  will  be  avoided.    If  chafings  do  occur  apply 
to  the  surgeon  for  a  healing  remedy,  for,  if  neglected, 
they  may  fester  and  cause  much  trouble. 

19.  A  hearty  meal  should  be  eaten  when  the 
day's  wrork  is  over,  but  the  soldier  should  eat  slowly, 
chewing  every  mouthful  into  a  smooth  pulp  before 
swallowing ;  and  it  is  good  when  one  can  rest  a  while 
after  this  meal.     Hard  bread  and  beans  when  not 
thoroughly  chewed   give   rise  to  diarrhea,   one   of 
the  most  dangerous  of  camp  diseases.    Fresh  meat 
should  be  eaten  sparingly  when  used  for  the  first 
time  after  some  days  on  salt  rations. 

20.  The  soldier  would  do  well  to  restrict  himself 
to  the   company   dietary.     Particularly   should   he 
avoid  the  articles  of  food  or  drink  for  sale  by  hawk- 
ers and  peddlers.     Green  fruit  and  overripe  fruit 
are  dangerous,  as  is  also  fruit  to  which  the  individual 
is  unaccustomed.     Unpeeled  fruit  should  never  be 
eaten,  for  it  may  have  been  handled  by  persons  suf- 
fering from  dangerous  infectious  diseases. 

21.  It  should  be  unnecessary  to  speak  of  the 
danger  from  the   use   of  intoxicating  liquors,   for 
every  soldier  knows  something  of  this.     The  mind 
of  a  man  under  the  influence  of  these  liquors  is  so 


—204— 

befogged  that  his  is  unable  to  protect  himself  from 
accidents  and  exposures.  How  many  men  have  been 
passed  from  this  world  because  of  exposures  during 
intoxication !  How  many  have  lost  their  health  and 
strength  and  become  wretched  sufferers  during  the 
remainder  of  a  shortened  existence!  Besides,  for 
days  after  indulgence  in  liquor  the  system  is  broken 
down  and  the  individual  less  able  to  stand  the  fa- 
tigues, exposures,  or  wounds  of  the  campaign. 

22.  If  filtered  or  condensed  water  is  not  furn- 
ished to  the  troops,  and  spring  water  is  not  to  be  had, 
each  soldier  should  fill  his  canteen  overnight  with 
weak  coffee  or  tea  for  the  next  day's  march.    This 
involves  boiling,  and  the  boiling  destroys  all  danger- 
ous substances  in  the  water.    Typhoid  fever,  cholera, 
and  dysentery  are  caused  by  impure  water. 

23.  All  the  belongings  of  the  soldier  should  be 
taken  under  shelter  at  night  to  protect  them  from 
rain  or  heavy  dews. 

24.  When  not  prevented  by  the  military  condi- 
tions, soldiers  should  sleep  in  their  shirts  and  draw- 
ers, removing  their  shoes,  socks,  and  other  clothing. 

25.  In  the  morning,  wrash  the  head,  face,  and 
neck  with  cold  water.     With  the  hair  kept  closely* 
cut  this  can  be  done  even  when  the  water  supply  is 
limited. 

26.  In  hot  climates,  where  marches  are  made 
or  other  military  work  performed  in  the  early  morn- 
ing or  late  in  the  evening,  a  sleep  should  be  taken 
after  the  midday  meal  to  make  up  for  the  shortened 
rest  at  night.     Everyone  to  keep  in  good  condition 
should  have  a  total  of  8  hours  sleep  in  the  24. 

27.  If  the  march  is  not  to  be  resumed,  the  sol- 
dier should  take  the  first  opportunity  of  improving 
his  sleeping  accommodations  by  building  a  bunk, 
raised  a  foot  and  a  half  or  more  from  the  ground. 


—205— 

This  is  of  the  first  importance  when  the  ground  is 
damp.  The  poncho,  or  slicker,  must  be  relied  upon 
as  a  protection  in  marching  camps,  but  when  the 
camp  is  to  be  occupied  for  some  days  bunks  should 
be  built. 

28.  Malaria  and  yellow  fever  are  caused  by  the 
bite  of  certain  varieties  of  mosquitoes  which  have 
at  sometime  before  bitten  a  person  having  one  of 
these  diseases.    They  do  not  usually  bite  while  the 
sun  is  above  the  horizon.    To  avoid  malaria  do  not 
sleep  in  or  near  the  houses  of  natives  of  malarious 
regions,  and  if  possible  protect  the  body  during  sleep 
with   a   mosquito   net,   which   should   be   carefully 
tucked  in  so  that  it  will  not  touch  the  bare  skin  of 
any  portion  of  the  body.    If  nets  are  not  available, 
smear  the  uncovered  skin  with  kerosene  or  some  oil 
having  a  strong  odor,  such  as  citronella  or  pepper- 
mint. 

29.  When  malarial  fevers  are  prevalent,  avoid 
chilling  the  body  by  sleeping  on  damp  ground  by 
building  a  bunk,  and  in  the  morning  take  hot  coffee 
immediately  after  roll  call.    Men  doing  duty  at  night 
should,  if  practicable,  have  a  lunch  and  some  coffee 
before  starting. 

30.  The  soldier  should  never  attempt  to  dose 
himself  with  medicine.     He  should  take  no  drugs 
except  such  as  are  prescribed  by  the  surgeon.. 

31.  No  matter  how  short  a  time  the  camp  is  to 
be  occupied,  its  surface  should  not  be  defiled.     The 
sinks  should  be  used  by  every  man,  and  the  regula- 
tions concerning  their  use  should  be  strictly  com- 
plied with.    Waste  water  and  refuse  of  food  should 
be  deposited  in  pits  or  other  receptacles  designed 
to  receive  them.    Attention  to  these  points  will  pre- 
vent foul  odors  and  flies. 


—206— 

32.  When  there  are  foul  odors  and  flies  in  a 
camp,  the  spread  of  typhoid  fever,  cholera,  dysen- 
tery, and  yellow  fever  is  likely  to  occur. 

33.  When  any  of  these  diseases  are  present  in 
a  command,  every  care  should  be  taken  to  have 
the  hands  freshly  washed  at  meal  times. 

34.  In  the  camps  of  field  service  the  interior  of 
tents  should  be  sunned  and  aired  daily,  and  efforts 
should  be  made  by  every  soldier  to  have  his  bunk, 
arms,  equipments,  and  clothing  in  as  neat  and  clean 
condition  as  if  he  were  in  barracks  at  a  permanent 
station. 

35.  Harmful  exposures  are  more  frequent  in  hot 
than    in    cold    weather.      Soldiers    seek    protection 
against  cold,  but  in  seeking  shade,  coolness,   and 
fresh  breezes  inhot  weather  they  often  expose  them- 
selves to  danger  from  diarrhea,,  dysentery,  pneu- 
monia, rheumatism,  and  other  diseases.     A  chill  is 
an  exciting  cause  of  these  affections;  it  should  be 
avoided  as  much  as  possible. 

36.  When  the  feet  become  wet  the  first  oppor- 
tunity should  be  taken  of  putting  on  dry  socks. 

37.  When  the  clothing  becomes  wet  in  crossing 
streams  or  in  rainstorms  there  is  little  danger  so 
long  as  active  exercise  is  kept  up,  but  there  is  great 
danger  if  one  rests  in  the  wet  clothing. 

38.  When  the  underclothes  are  wet  with  per- 
spiration the  danger  is  from  chill  after  the  exercise 
which  caused  the  perspiration  is  ended.    If  the  sol- 
dier can  not  give  himself  a  towel  rub  and  a  change 
of  underclothing,  he  should  put  on  his  blouse  and 
move  about  until  his  skin  and  clothes  become  dry. 

39.  To  rest  or  cool  off,  and  particularly  to  fall 
asleep,  in  a  cool,  shady  place  in  damp  clothes  is  to 
invite   suffering,   perhaps   permanent   disability   or 
death. 


—207— 

40.  When  an  infectious  disease  is  known  to  be 
present  among  the  civil  population  in  the  neighbor- 
hodd  of  a  military  camp  or  station,  care  should  be 
taken  by  every  member  of  the  command  to  avoid 
exposure  to  the  infection.    Protection  from  smallpox 
and  typhoid  fever  can  be  obtained  by  timely  vac- 
cinations against  these  diseases,  repeated  when  nec- 
cessary.    Scarlet  fever,  measles,  and  diphtheria  are 
met  with  in  the  United  States,  but  in  some  localities 
our  troops  may  have  to  guard  against   smallpox, 
yellow  fever,  cholera,  and  bubonic  plague.    The  care- 
less or  reckless  individual  will  be  the  first  to  suffer, 
but  he  may  not  suffer  alone ;  many  of  his  comrades 
may  become  affected  and  die  through  his  fault. 

41.  Such  infections  prevail  mostly  among  the 
lower  classes  of  a  community  who  have  no  knowledge 
of  the  difference  between  healthful  and  unhealthf ul 
conditions  of  life.     Association  with  them  and  the 
use  of  their  dwellings,  especially  for  sleeping  pur- 
poses, should  be  avoided. 

42.  The  most  serious  risk  to  which  the  health 
of  young  men  is  exposed*  both  in  military  and  civil 
life  is  one  of  their  own  making,  that  of  venereal  dis- 
eases contracted  by  association  with  lewd  women. 
There  are  three  of  these  diseases — syphilis  or  pox, 
gonorrhea  or  clap,  and  chancroid  or  soft  chancre,  of 
which  the  first  two  are  the  more  serious.     Syphilis 
is  a  blood  disease  which  begins  as  a  small  hard  sore 
and  may  affect  any  part  or  organ  of  the  body.    Sores 
in  the  mouth  are  very  common  in  this  disease  and 
render  anything  with  which  the  lips  come  in  contact 
dangerous,  as  is  contact  with  a  sore  in  any  other  part 
of  the  body.    Therefore,  persons  with  syphilis  should 
not  allow  others  to  use  their  drinking  cups,  spoons, 
forks,  pipes,  towels,  etc. 


—208— 

Gonorrhea  is  an  infection  of  the  lining  of  the 
penis  and  causes  a  burning  when  passing  water, 
and  a  white  discharge.  It  is  the  cause  of  stricture, 
inflammation  of  the  bladder,  and  other  serious 
troubles,  and  is  very  hard  to  cure  completely.  The 
discharge  is  often  a  cause  of  blindness,  if  by  unclean 
hands  it  is  carried  to  the  eyes.  A  soldier  who  be- 
comes infected  with  these  diseases  should  be  very 
careful  to  keep  his  hands  and  person  very  clean 
and  should  promptly  consult  an  Army  surgeon  and 
carefully  follow  his  advice,  both  for  his  own  sake 
and  that  of  his  companions.  The  advice  and  treat- 
ment of  friends  who  are  not  physicians  and  of  quacks 
should  never  be  taken.  The  great  majority  of  pro- 
stitutes and  other  women  of  immoral  life  become 
infected  sooner  or  later  with  one  or  both  of  these 
diseases,  and  give  them  to  men  who  have  intercourse 
with  them.  The  only  sure  way  to  avoid  danger 
of  getting  these  diseases  is  to  live  a  clean  and  moral 
life.  It  is  stated  by  medical  authorities  that  sexual 
intercourse  is  not  necessary  to  preserve  health  and 
manly  vigor,  and  the  natural  sexual  impulse  can  be 
kept  under  control  by  avoiding  associations,  conver- 
sations, and  thought  of  a  lewd  character.  Persons 
who  will  nt  exercise  self-control  in  this  matter  can 
greatly  lessen  the  risks  of  indulgence  by  intelligence 
and  a  care  in  the  practice  of  personal  cleanliness 
and  the  prompt  use  of  the  means  of  venereal  pro- 
phylaxis prescribed  by  Army  order  for  those  who 
have  exposed  themselves.  Men  who  immediately 
after  intercourse  urinate  and  wash  the  private  parts 
thoroughly  with  soap  and  water  will  usually  escape 
disease  as  will  those  who  use  the  covering  called  the 
condom.  Drunkenness  greatly  increases  the  risk  of 
infection. 


—209— 

43.  Every  soldier  should  become  familiar  with 
the  instructions  in  the  "First  Aid  and  Personal  Hy- 
giene/' so  as  to  be  able  to  help  himself  or  others 
in  the  event  of  wounds  or  accidents. 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 
BERKELEY 

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MAY  1  0  1949 


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